pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	mrx_tier_label_list	mrx_tier_benefit_type	mrx_tier_drug_type	mrx_tier_includes	mrx_tier_cstshr_struct_type	mrx_tier_id	mrx_tier_type_id	mrx_tier_locat_rstd	mrx_tier_locat_rsplt	mrx_tier_locat_oon	mrx_tier_locat_mostd	mrx_tier_locat_mosplt	mrx_tier_locat_ltc	mrx_tier_rstd_1m_num	mrx_tier_rstd_2m_num	mrx_tier_rstd_3m_num	mrx_tier_rsplt_1m_num	mrx_tier_rsplt_2m_num	mrx_tier_rsplt_3m_num	mrx_tier_extd_days_yn	mrx_tier_extd_first_fill	mrx_tier_mostd_1m_num	mrx_tier_mostd_2m_num	mrx_tier_mostd_3m_num	mrx_tier_mosplt_1m_num	mrx_tier_mosplt_2m_num	mrx_tier_mosplt_3m_num	mrx_tier_oonp_1m_num	mrx_tier_oonp_othnumn	mrx_tier_ltcp_1m	mrx_tier_rstd_copay_1m	mrx_tier_rstd_copay_2m	mrx_tier_rstd_copay_3m	mrx_tier_rstd_coins_avg_1m	mrx_tier_rstd_coins_1m	mrx_tier_rstd_coins_2m	mrx_tier_rstd_coins_3m	mrx_tier_rsstd_copay_1m	mrx_tier_rsstd_copay_2m	mrx_tier_rsstd_copay_3m	mrx_tier_rsstd_coins_avg_1m	mrx_tier_rsstd_coins_1m	mrx_tier_rsstd_coins_2m	mrx_tier_rsstd_coins_3m	mrx_tier_rspfd_copay_1m	mrx_tier_rspfd_copay_2m	mrx_tier_rspfd_copay_3m	mrx_tier_rspfd_coins_avg_1m	mrx_tier_rspfd_coins_1m	mrx_tier_rspfd_coins_2m	mrx_tier_rspfd_coins_3m	mrx_tier_mostd_copay_1m	mrx_tier_mostd_copay_2m	mrx_tier_mostd_copay_3m	mrx_tier_mostd_coins_1m	mrx_tier_mostd_coins_2m	mrx_tier_mostd_coins_3m	mrx_tier_mosstd_copay_1m	mrx_tier_mosstd_copay_2m	mrx_tier_mosstd_copay_3m	mrx_tier_mosstd_coins_1m	mrx_tier_mosstd_coins_2m	mrx_tier_mosstd_coins_3m	mrx_tier_mospfd_copay_1m	mrx_tier_mospfd_copay_2m	mrx_tier_mospfd_copay_3m	mrx_tier_mospfd_coins_1m	mrx_tier_mospfd_coins_2m	mrx_tier_mospfd_coins_3m	mrx_tier_oonp_copay_1m	mrx_tier_oonp_copay_othnum	mrx_tier_oonp_coins_1m	mrx_tier_oonp_coins_othnum	mrx_tier_ltcp_copay_1m	mrx_tier_ltcp_coins_1m	mrx_tier_rstd_copay_daily	mrx_tier_rsstd_copay_daily	mrx_tier_rspfd_copay_daily	mrx_tier_mostd_copay_daily	mrx_tier_mosstd_copay_daily	mrx_tier_mospfd_copay_daily	mrx_tier_ltcp_copay_daily	mrx_tier_form_model_desc	mrx_tier_includes_mmp	mrx_tier_copay_amt_rstd_mmpmin	mrx_tier_copay_amt_rstd_mmpmax	mrx_tier_copay_amt_oon_mmpmin	mrx_tier_copay_amt_oon_mmpmax	mrx_tier_copay_amt_mstd_mmpmin	mrx_tier_copay_amt_mstd_mmpmax	mrx_tier_copay_amt_ltc_mmpmin	mrx_tier_copay_amt_ltc_mmpmax	mrx_tier_gap_cost_share	mrx_tier_gap_part_drugs	mrx_tier_gap_part_includes
H0022	001	0	1	48	05	H0022_001_0	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			
H0022	001	0	1	48	05	H0022_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			
H0022	001	0	1	48	05	H0022_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0028	007	0	1	01	01	H0028_007_0	7	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	7	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	7	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	007	0	1	01	01	H0028_007_0	7	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	013	0	1	01	01	H0028_013_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	013	0	1	01	01	H0028_013_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	013	0	1	01	01	H0028_013_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	013	0	1	01	01	H0028_013_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	015	0	1	01	01	H0028_015_0	7	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	015	0	1	01	01	H0028_015_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	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	016	0	1	01	01	H0028_016_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	01	01	H0028_016_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	018	0	1	01	01	H0028_018_0	6	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	018	0	1	01	01	H0028_018_0	6	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	018	0	1	01	01	H0028_018_0	6	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	018	0	1	01	01	H0028_018_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	018	0	1	01	01	H0028_018_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_0	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	029	0	1	01	01	H0028_029_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	029	0	1	01	01	H0028_029_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	4	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
H0028	030	0	1	01	01	H0028_030_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	4	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		
H0028	030	0	1	01	01	H0028_030_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	031	0	1	01	01	H0028_031_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	031	0	1	01	01	H0028_031_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	031	0	1	01	01	H0028_031_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	031	0	1	01	01	H0028_031_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	031	0	1	01	01	H0028_031_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	032	0	1	01	01	H0028_032_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	032	0	1	01	01	H0028_032_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	032	0	1	01	01	H0028_032_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	032	0	1	01	01	H0028_032_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												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	6	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	033	0	1	01	01	H0028_033_0	6	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	033	0	1	01	01	H0028_033_0	6	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	033	0	1	01	01	H0028_033_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	033	0	1	01	01	H0028_033_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	034	0	1	01	01	H0028_034_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	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	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	034	0	1	01	01	H0028_034_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	034	0	1	01	01	H0028_034_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	035	0	1	01	01	H0028_035_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	035	0	1	01	01	H0028_035_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_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												
H0028	037	0	1	01	01	H0028_037_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	037	0	1	01	01	H0028_037_0	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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										1		
H0028	037	0	1	01	01	H0028_037_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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		
H0028	037	0	1	01	01	H0028_037_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	039	0	1	01	01	H0028_039_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	039	0	1	01	01	H0028_039_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	039	0	1	01	01	H0028_039_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	5	Preferred Generic	4	11	1	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		
H0028	041	0	1	01	01	H0028_041_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	5	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		
H0028	041	0	1	01	01	H0028_041_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	042	0	1	01	01	H0028_042_0	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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		
H0028	042	0	1	01	01	H0028_042_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	042	0	1	01	01	H0028_042_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	042	0	1	01	01	H0028_042_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	043	1	1	01	01	H0028_043_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	4	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		
H0028	043	1	1	01	01	H0028_043_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	043	2	1	01	01	H0028_043_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	4	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		
H0028	043	2	1	01	01	H0028_043_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	044	0	1	01	01	H0028_044_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	044	0	1	01	01	H0028_044_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	044	0	1	01	01	H0028_044_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	044	0	1	01	01	H0028_044_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	045	0	1	01	01	H0028_045_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								16.00		48.00					15.00		45.00											16.00		48.00				15.00		0.00				16.00				16.00			0.53	0.50		0.53	0.50	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	045	0	1	01	01	H0028_045_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	045	0	1	01	01	H0028_045_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	045	0	1	01	01	H0028_045_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	045	0	1	01	01	H0028_045_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	046	0	1	01	01	H0028_046_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	046	0	1	01	01	H0028_046_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	046	0	1	01	01	H0028_046_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	Specialty Tier	4	11	1	1	5	1		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	047	0	1	01	01	H0028_047_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	047	0	1	01	01	H0028_047_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	047	0	1	01	01	H0028_047_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	047	0	1	01	01	H0028_047_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	2	1	01	01	H0028_048_2	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	048	2	1	01	01	H0028_048_2	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	048	2	1	01	01	H0028_048_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	2	1	01	01	H0028_048_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	2	1	01	01	H0028_048_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	049	0	1	01	01	H0028_049_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	049	0	1	01	01	H0028_049_0	5	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	049	0	1	01	01	H0028_049_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	049	0	1	01	01	H0028_049_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	049	0	1	01	01	H0028_049_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	050	0	1	01	01	H0028_050_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	050	0	1	01	01	H0028_050_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	050	0	1	01	01	H0028_050_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	050	0	1	01	01	H0028_050_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	050	0	1	01	01	H0028_050_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	050	0	1	01	01	H0028_050_0	5	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	051	0	1	01	01	H0028_051_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	051	0	1	01	01	H0028_051_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	051	0	1	01	01	H0028_051_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	051	0	1	01	01	H0028_051_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	051	0	1	01	01	H0028_051_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	051	0	1	01	01	H0028_051_0	5	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	052	0	1	01	01	H0028_052_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	052	0	1	01	01	H0028_052_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	052	0	1	01	01	H0028_052_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	052	0	1	01	01	H0028_052_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	052	0	1	01	01	H0028_052_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	1	1	01	01	H0028_053_1	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	1	1	01	01	H0028_053_1	6	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	053	1	1	01	01	H0028_053_1	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	1	1	01	01	H0028_053_1	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	1	1	01	01	H0028_053_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	2	1	01	01	H0028_053_2	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	2	1	01	01	H0028_053_2	6	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	053	2	1	01	01	H0028_053_2	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	2	1	01	01	H0028_053_2	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	2	1	01	01	H0028_053_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	3	1	01	01	H0028_053_3	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	3	1	01	01	H0028_053_3	6	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	053	3	1	01	01	H0028_053_3	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	3	1	01	01	H0028_053_3	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	3	1	01	01	H0028_053_3	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	4	1	01	01	H0028_053_4	8	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	053	4	1	01	01	H0028_053_4	8	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	053	4	1	01	01	H0028_053_4	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	053	4	1	01	01	H0028_053_4	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	053	4	1	01	01	H0028_053_4	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0062	002	0	1	01	01	H0062_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					14.00	28.00	42.00											19.00	38.00	57.00				14.00	28.00	0.00				19.00				19.00			0.63	0.47		0.63	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	Preferred Brand	4	11	1	2	3	1		111	01		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												
H0062	002	0	1	01	01	H0062_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				17.00			0.57	0.4		0.57	0.4	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	Preferred Brand	4	11	1	2	3	1		111	01		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												
H0062	003	0	1	01	01	H0062_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					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	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0074	001	0	1	04	01	H0074_001_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0074	001	0	1	04	01	H0074_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0074	001	0	1	04	01	H0074_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H0074	001	0	1	04	01	H0074_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0074	001	0	1	04	01	H0074_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0074	001	0	1	04	01	H0074_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0074	002	0	1	04	01	H0074_002_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0074	002	0	1	04	01	H0074_002_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0074	002	0	1	04	01	H0074_002_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H0074	002	0	1	04	01	H0074_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					30.00	60.00	90.00											40.00	80.00	120.00				30.00	60.00	60.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0074	002	0	1	04	01	H0074_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								95.00	190.00	285.00					85.00	170.00	255.00											95.00	190.00	285.00				85.00	170.00	170.00				95.00				95.00			3.17	2.83		3.17	2.83	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0074	002	0	1	04	01	H0074_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0074	002	0	1	04	01	H0074_002_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0074	002	0	1	04	01	H0074_002_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0074	003	0	1	04	01	H0074_003_0	5	Preferred Generic	4	11	3	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, Select Care Drugs												
H0074	003	0	1	04	01	H0074_003_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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												
H0074	003	0	1	04	01	H0074_003_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H0074	003	0	1	04	01	H0074_003_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											96.77	45	45	45				92.47	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0074	003	0	1	04	01	H0074_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0074	003	0	1	04	01	H0074_003_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0088	002	0	1	04	01	H0088_002_0	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0088	002	0	1	04	01	H0088_002_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H0088	002	0	1	04	01	H0088_002_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H0088	002	0	1	04	01	H0088_002_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.85	50	50	50				87.22	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0088	002	0	1	04	01	H0088_002_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0088	002	0	1	04	01	H0088_002_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0088	002	0	1	04	01	H0088_002_0	6	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0088	003	0	1	04	01	H0088_003_0	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0088	003	0	1	04	01	H0088_003_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H0088	003	0	1	04	01	H0088_003_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H0088	003	0	1	04	01	H0088_003_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.86	46	46	46				93.60	44	44	44										46	46	46				44	44	44			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0088	003	0	1	04	01	H0088_003_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0088	003	0	1	04	01	H0088_003_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0088	003	0	1	04	01	H0088_003_0	6	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0104	012	0	1	04	01	H0104_012_0	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					40.00		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	5	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											98.10	37		37				75.90	32		32				32		32															37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	5	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		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, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	5	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	5	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	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					40.00		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	5	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											86.40	37		37				79.60	32		32				32		32															37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	5	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		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, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	5	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	5	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	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		30.00					3.00		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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					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	7	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											99.50	47		47				83.50	42		42				42		42															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	7	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	7	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	7	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	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	003	0	1	04	01	H0107_003_0	4	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H0107	003	0	1	04	01	H0107_003_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	003	0	1	04	01	H0107_003_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H0107	003	0	1	04	01	H0107_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	003	0	1	04	01	H0107_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	004	0	1	04	01	H0107_004_0	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	004	0	1	04	01	H0107_004_0	6	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H0107	004	0	1	04	01	H0107_004_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	004	0	1	04	01	H0107_004_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				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												
H0107	004	0	1	04	01	H0107_004_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	004	0	1	04	01	H0107_004_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	005	0	1	04	01	H0107_005_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	005	0	1	04	01	H0107_005_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H0107	005	0	1	04	01	H0107_005_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	005	0	1	04	01	H0107_005_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H0107	005	0	1	04	01	H0107_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	005	0	1	04	01	H0107_005_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	006	0	1	04	01	H0107_006_0	2	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	006	0	1	04	01	H0107_006_0	2	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		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												
H0107	006	0	1	04	01	H0107_006_0	2	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					44.00		132.00											47.00		141.00				44.00		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												
H0107	006	0	1	04	01	H0107_006_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											96.32	50		50				87.95	45		45										50		50				45		45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	006	0	1	04	01	H0107_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												
H0111	001	0	1	04	01	H0111_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	001	0	1	04	01	H0111_001_0	4	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					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												
H0111	001	0	1	04	01	H0111_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H0111	001	0	1	04	01	H0111_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.29	43	43	43				94.67	41	41	41										43	43	43				41	41	41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	001	0	1	04	01	H0111_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	001	0	1	04	01	H0111_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	001	0	1	04	01	H0111_001_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0111	002	0	1	04	01	H0111_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	002	0	1	04	01	H0111_002_0	4	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					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												
H0111	002	0	1	04	01	H0111_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H0111	002	0	1	04	01	H0111_002_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.03	40	40	40				94.07	38	38	38										40	40	40				38	38	38			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	002	0	1	04	01	H0111_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	002	0	1	04	01	H0111_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	002	0	1	04	01	H0111_002_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0111	003	0	1	04	01	H0111_003_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	003	0	1	04	01	H0111_003_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0111	003	0	1	04	01	H0111_003_0	4	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					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												
H0111	003	0	1	04	01	H0111_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H0111	003	0	1	04	01	H0111_003_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.62	50	50	50				85.08	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	003	0	1	04	01	H0111_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	003	0	1	04	01	H0111_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	003	0	1	04	01	H0111_003_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0111	004	0	1	04	01	H0111_004_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	004	0	1	04	01	H0111_004_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	9.00	18.00	27.00																									9.00	18.00	27.00				9.00	18.00	0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	004	0	1	04	01	H0111_004_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	120.00																									40.00	80.00	120.00				40.00	80.00	80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	004	0	1	04	01	H0111_004_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.42	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	004	0	1	04	01	H0111_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	004	0	1	04	01	H0111_004_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	005	0	1	04	01	H0111_005_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	005	0	1	04	01	H0111_005_0	5	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					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												
H0111	005	0	1	04	01	H0111_005_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					30.00	60.00	90.00											40.00	80.00	120.00				30.00	60.00	60.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	005	0	1	04	01	H0111_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0111	005	0	1	04	01	H0111_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	005	0	1	04	01	H0111_005_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0111	005	0	1	04	01	H0111_005_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0137	001	0	1	48	05	H0137_001_0	5	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	5	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	5	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	5	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	5	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	1	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	1	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	3.95					0.00	3.95			
H0148	001	0	1	48	05	H0148_001_0	1	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	9.85					0.00	9.85			
H0148	001	0	1	48	05	H0148_001_0	1	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	1	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	1	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	3.95					0.00	3.95			
H0148	002	0	1	48	05	H0148_002_0	1	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	9.85					0.00	9.85			
H0148	002	0	1	48	05	H0148_002_0	1	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	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	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	6	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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	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	6	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	6	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	6	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	6	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	6	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	6	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	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	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	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	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	6	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	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	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	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	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	6	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	2	1	01	01	H0154_015_2	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	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	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	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	6	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	016	0	1	01	01	H0154_016_0	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	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	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											56.75	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												
H0154	016	0	1	01	01	H0154_016_0	6	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	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	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	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	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	6	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	018	0	1	01	01	H0154_018_0	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	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	6	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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	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	6	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	6	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	6	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	6	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	6	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	6	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	020	0	1	01	01	H0154_020_0	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	020	0	1	01	01	H0154_020_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					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	020	0	1	01	01	H0154_020_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	020	0	1	01	01	H0154_020_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	020	0	1	01	01	H0154_020_0	6	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	33						1.00	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	002	0	1	01	01	H0174_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	002	0	1	01	01	H0174_002_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0174	002	0	1	01	01	H0174_002_0	4	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					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												
H0174	002	0	1	01	01	H0174_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H0174	002	0	1	01	01	H0174_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0174	002	0	1	01	01	H0174_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	002	0	1	01	01	H0174_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	002	0	1	01	01	H0174_002_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0174	004	0	1	01	01	H0174_004_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	004	0	1	01	01	H0174_004_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	004	0	1	01	01	H0174_004_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	004	0	1	01	01	H0174_004_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.85	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	004	0	1	01	01	H0174_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	004	0	1	01	01	H0174_004_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	006	0	1	01	01	H0174_006_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	006	0	1	01	01	H0174_006_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	006	0	1	01	01	H0174_006_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H0174	006	0	1	01	01	H0174_006_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.56	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	006	0	1	01	01	H0174_006_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	006	0	1	01	01	H0174_006_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		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	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0174	008	0	1	01	01	H0174_008_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2	2	3
H0174	008	0	1	01	01	H0174_008_0	4	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					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0174	008	0	1	01	01	H0174_008_0	4	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	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H0174	008	0	1	01	01	H0174_008_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
H0174	008	0	1	01	01	H0174_008_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Diabetic Drugs												
H0174	008	0	1	01	01	H0174_008_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0174	008	0	1	01	01	H0174_008_0	4	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					10.00	20.00	30.00											10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0174	008	0	1	01	01	H0174_008_0	4	Select Diabetic Drugs	4	10	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					10.00	20.00	30.00											10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2		
H0174	009	0	1	01	01	H0174_009_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	009	0	1	01	01	H0174_009_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	009	0	1	01	01	H0174_009_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	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, Select Care Drugs												
H0174	009	0	1	01	01	H0174_009_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.26	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	009	0	1	01	01	H0174_009_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	009	0	1	01	01	H0174_009_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	010	0	1	01	01	H0174_010_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	010	0	1	01	01	H0174_010_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0174	010	0	1	01	01	H0174_010_0	4	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					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												
H0174	010	0	1	01	01	H0174_010_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	40.00				30.00				30.00			1.00	0.67		1.00	0.67	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	010	0	1	01	01	H0174_010_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	240.00											90.00	180.00	270.00				80.00	160.00	160.00				90.00				90.00			3.00	2.67		3.00	2.67	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	010	0	1	01	01	H0174_010_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	010	0	1	01	01	H0174_010_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	010	0	1	01	01	H0174_010_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0174	011	1	1	01	01	H0174_011_1	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	1	1	01	01	H0174_011_1	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0174	011	1	1	01	01	H0174_011_1	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	1	1	01	01	H0174_011_1	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H0174	011	1	1	01	01	H0174_011_1	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	240.00											90.00	180.00	270.00				80.00	160.00	160.00				90.00				90.00			3.00	2.67		3.00	2.67	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	1	1	01	01	H0174_011_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	1	1	01	01	H0174_011_1	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	1	1	01	01	H0174_011_1	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0174	011	2	1	01	01	H0174_011_2	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	2	1	01	01	H0174_011_2	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0174	011	2	1	01	01	H0174_011_2	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	2	1	01	01	H0174_011_2	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H0174	011	2	1	01	01	H0174_011_2	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	240.00											90.00	180.00	270.00				80.00	160.00	160.00				90.00				90.00			3.00	2.67		3.00	2.67	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	2	1	01	01	H0174_011_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	2	1	01	01	H0174_011_2	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	2	1	01	01	H0174_011_2	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0174	011	3	1	01	01	H0174_011_3	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	3	1	01	01	H0174_011_3	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0174	011	3	1	01	01	H0174_011_3	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	3	1	01	01	H0174_011_3	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H0174	011	3	1	01	01	H0174_011_3	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	240.00											90.00	180.00	270.00				80.00	160.00	160.00				90.00				90.00			3.00	2.67		3.00	2.67	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	3	1	01	01	H0174_011_3	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	3	1	01	01	H0174_011_3	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	3	1	01	01	H0174_011_3	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0174	011	4	1	01	01	H0174_011_4	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	4	1	01	01	H0174_011_4	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0174	011	4	1	01	01	H0174_011_4	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	4	1	01	01	H0174_011_4	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H0174	011	4	1	01	01	H0174_011_4	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	240.00											90.00	180.00	270.00				80.00	160.00	160.00				90.00				90.00			3.00	2.67		3.00	2.67	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	4	1	01	01	H0174_011_4	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	4	1	01	01	H0174_011_4	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	011	4	1	01	01	H0174_011_4	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0174	012	1	1	02	01	H0174_012_1	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	1	1	02	01	H0174_012_1	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0174	012	1	1	02	01	H0174_012_1	4	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					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												
H0174	012	1	1	02	01	H0174_012_1	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	40.00				30.00				30.00			1.00	0.67		1.00	0.67	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	1	1	02	01	H0174_012_1	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								85.00	170.00	255.00					75.00	150.00	225.00											85.00	170.00	255.00				75.00	150.00	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, Select Care Drugs												
H0174	012	1	1	02	01	H0174_012_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	1	1	02	01	H0174_012_1	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	1	1	02	01	H0174_012_1	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0174	012	2	1	02	01	H0174_012_2	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	2	1	02	01	H0174_012_2	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0174	012	2	1	02	01	H0174_012_2	4	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					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												
H0174	012	2	1	02	01	H0174_012_2	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	40.00				30.00				30.00			1.00	0.67		1.00	0.67	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	2	1	02	01	H0174_012_2	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								85.00	170.00	255.00					75.00	150.00	225.00											85.00	170.00	255.00				75.00	150.00	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, Select Care Drugs												
H0174	012	2	1	02	01	H0174_012_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	2	1	02	01	H0174_012_2	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	2	1	02	01	H0174_012_2	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0174	012	3	1	02	01	H0174_012_3	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	3	1	02	01	H0174_012_3	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0174	012	3	1	02	01	H0174_012_3	4	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					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												
H0174	012	3	1	02	01	H0174_012_3	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	40.00				30.00				30.00			1.00	0.67		1.00	0.67	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	3	1	02	01	H0174_012_3	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								85.00	170.00	255.00					75.00	150.00	225.00											85.00	170.00	255.00				75.00	150.00	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, Select Care Drugs												
H0174	012	3	1	02	01	H0174_012_3	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	3	1	02	01	H0174_012_3	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	3	1	02	01	H0174_012_3	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0174	012	4	1	02	01	H0174_012_4	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	4	1	02	01	H0174_012_4	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0174	012	4	1	02	01	H0174_012_4	4	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					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												
H0174	012	4	1	02	01	H0174_012_4	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	40.00				30.00				30.00			1.00	0.67		1.00	0.67	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	4	1	02	01	H0174_012_4	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								85.00	170.00	255.00					75.00	150.00	225.00											85.00	170.00	255.00				75.00	150.00	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, Select Care Drugs												
H0174	012	4	1	02	01	H0174_012_4	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	4	1	02	01	H0174_012_4	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	4	1	02	01	H0174_012_4	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0174	012	5	1	02	01	H0174_012_5	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	5	1	02	01	H0174_012_5	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0174	012	5	1	02	01	H0174_012_5	4	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					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												
H0174	012	5	1	02	01	H0174_012_5	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	40.00				30.00				30.00			1.00	0.67		1.00	0.67	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	5	1	02	01	H0174_012_5	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								85.00	170.00	255.00					75.00	150.00	225.00											85.00	170.00	255.00				75.00	150.00	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, Select Care Drugs												
H0174	012	5	1	02	01	H0174_012_5	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	5	1	02	01	H0174_012_5	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	012	5	1	02	01	H0174_012_5	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0174	013	1	1	01	01	H0174_013_1	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	1	1	01	01	H0174_013_1	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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, Select Care Drugs												
H0174	013	1	1	01	01	H0174_013_1	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	40.00				30.00				30.00			1.00	0.67		1.00	0.67	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	1	1	01	01	H0174_013_1	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0174	013	1	1	01	01	H0174_013_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	1	1	01	01	H0174_013_1	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	2	1	01	01	H0174_013_2	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	2	1	01	01	H0174_013_2	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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, Select Care Drugs												
H0174	013	2	1	01	01	H0174_013_2	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	40.00				30.00				30.00			1.00	0.67		1.00	0.67	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	2	1	01	01	H0174_013_2	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0174	013	2	1	01	01	H0174_013_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	2	1	01	01	H0174_013_2	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	3	1	01	01	H0174_013_3	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	3	1	01	01	H0174_013_3	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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, Select Care Drugs												
H0174	013	3	1	01	01	H0174_013_3	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	40.00				30.00				30.00			1.00	0.67		1.00	0.67	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	3	1	01	01	H0174_013_3	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0174	013	3	1	01	01	H0174_013_3	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	3	1	01	01	H0174_013_3	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	4	1	01	01	H0174_013_4	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	4	1	01	01	H0174_013_4	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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, Select Care Drugs												
H0174	013	4	1	01	01	H0174_013_4	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	40.00				30.00				30.00			1.00	0.67		1.00	0.67	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	4	1	01	01	H0174_013_4	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0174	013	4	1	01	01	H0174_013_4	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	4	1	01	01	H0174_013_4	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	5	1	01	01	H0174_013_5	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	5	1	01	01	H0174_013_5	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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, Select Care Drugs												
H0174	013	5	1	01	01	H0174_013_5	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	40.00				30.00				30.00			1.00	0.67		1.00	0.67	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	5	1	01	01	H0174_013_5	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0174	013	5	1	01	01	H0174_013_5	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	013	5	1	01	01	H0174_013_5	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	014	0	1	01	01	H0174_014_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	014	0	1	01	01	H0174_014_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0174	014	0	1	01	01	H0174_014_0	4	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					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												
H0174	014	0	1	01	01	H0174_014_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	40.00				30.00				30.00			1.00	0.67		1.00	0.67	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	014	0	1	01	01	H0174_014_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								85.00	170.00	255.00					75.00	150.00	225.00											85.00	170.00	255.00				75.00	150.00	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, Select Care Drugs												
H0174	014	0	1	01	01	H0174_014_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	014	0	1	01	01	H0174_014_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	014	0	1	01	01	H0174_014_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0192	001	0	1	48	05	H0192_001_0	5	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	5	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	5	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	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0270	001	0	1	04	01	H0270_001_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	7.00	14.00	21.00																									7.00	14.00	21.00				7.00	14.00	0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0270	001	0	1	04	01	H0270_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	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, Select Care Drugs												
H0270	001	0	1	04	01	H0270_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	99.00	198.00	297.00																									99.00	198.00	297.00				99.00	198.00	198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0270	001	0	1	04	01	H0270_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0270	001	0	1	04	01	H0270_001_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0270	002	0	1	04	01	H0270_002_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0270	002	0	1	04	01	H0270_002_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	9.00	18.00	27.00																									9.00	18.00	27.00				9.00	18.00	0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0270	002	0	1	04	01	H0270_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	120.00																									40.00	80.00	120.00				40.00	80.00	80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0270	002	0	1	04	01	H0270_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.27	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0270	002	0	1	04	01	H0270_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0270	002	0	1	04	01	H0270_002_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0292	001	0	1	01	01	H0292_001_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	001	0	1	01	01	H0292_001_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	001	0	1	01	01	H0292_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H0294	002	0	1	04	01	H0294_002_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	002	0	1	04	01	H0294_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				299.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	004	0	1	04	01	H0294_004_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	004	0	1	04	01	H0294_004_0	3	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												
H0294	004	0	1	04	01	H0294_004_0	3	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
H0294	004	0	1	04	01	H0294_004_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				294.00	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	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	010	0	1	04	01	H0294_010_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	010	0	1	04	01	H0294_010_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	010	0	1	04	01	H0294_010_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	010	0	1	04	01	H0294_010_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	010	0	1	04	01	H0294_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	010	0	1	04	01	H0294_010_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				205.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	011	0	1	04	01	H0294_011_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	011	0	1	04	01	H0294_011_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	011	0	1	04	01	H0294_011_0	3	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												
H0294	011	0	1	04	01	H0294_011_0	3	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
H0294	011	0	1	04	01	H0294_011_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	011	0	1	04	01	H0294_011_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	011	0	1	04	01	H0294_011_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				255.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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		
H0294	012	0	1	04	01	H0294_012_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	012	0	1	04	01	H0294_012_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	012	0	1	04	01	H0294_012_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	012	0	1	04	01	H0294_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	012	0	1	04	01	H0294_012_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				195.00	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	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	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		
H0294	015	0	1	04	01	H0294_015_0	3	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												
H0294	015	0	1	04	01	H0294_015_0	3	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
H0294	015	0	1	04	01	H0294_015_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											171.00	29						360.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	016	0	1	04	01	H0294_016_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	016	0	1	04	01	H0294_016_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				317.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	017	0	1	04	01	H0294_017_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	017	0	1	04	01	H0294_017_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				472.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	018	0	1	04	01	H0294_018_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	018	0	1	04	01	H0294_018_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	018	0	1	04	01	H0294_018_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	018	0	1	04	01	H0294_018_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	018	0	1	04	01	H0294_018_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	018	0	1	04	01	H0294_018_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	018	0	1	04	01	H0294_018_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				507.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	019	0	1	04	01	H0294_019_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	019	0	1	04	01	H0294_019_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	019	0	1	04	01	H0294_019_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	019	0	1	04	01	H0294_019_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	019	0	1	04	01	H0294_019_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	019	0	1	04	01	H0294_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	019	0	1	04	01	H0294_019_0	3	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												
H0294	020	0	1	04	01	H0294_020_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	020	0	1	04	01	H0294_020_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	020	0	1	04	01	H0294_020_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	020	0	1	04	01	H0294_020_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	020	0	1	04	01	H0294_020_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	020	0	1	04	01	H0294_020_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	020	0	1	04	01	H0294_020_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				507.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	021	0	1	04	01	H0294_021_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	021	0	1	04	01	H0294_021_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	021	0	1	04	01	H0294_021_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	021	0	1	04	01	H0294_021_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	021	0	1	04	01	H0294_021_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	021	0	1	04	01	H0294_021_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	021	0	1	04	01	H0294_021_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				430.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	023	0	1	04	01	H0294_023_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	023	0	1	04	01	H0294_023_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H0294	023	0	1	04	01	H0294_023_0	3	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												
H0294	023	0	1	04	01	H0294_023_0	3	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
H0294	023	0	1	04	01	H0294_023_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	023	0	1	04	01	H0294_023_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	023	0	1	04	01	H0294_023_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				256.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	9	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	9	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	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	9	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	001	0	1	01	01	H0302_001_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1179.38	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	9	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	9	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	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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	9	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	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1361.63	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	9	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	9	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	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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	9	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	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1235.75	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	009	0	1	01	01	H0302_009_0	9	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	9	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	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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	9	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	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1215.53	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	6	Preferred Generic	4	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	6	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	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	6	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	6	Generic	4	11	3	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0332	002	0	1	01	01	H0332_002_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	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	6	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	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	6	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	6	Generic	4	11	3	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0332	004	0	1	02	01	H0332_004_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	008	0	1	02	01	H0332_008_0	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	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	6	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	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	6	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	008	0	1	02	01	H0332_008_0	6	Generic	4	11	3	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0332	008	0	1	02	01	H0332_008_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	009	0	1	01	01	H0332_009_0	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	009	0	1	01	01	H0332_009_0	6	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	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	009	0	1	01	01	H0332_009_0	6	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	009	0	1	01	01	H0332_009_0	6	Generic	4	11	3	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0332	009	0	1	01	01	H0332_009_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	009	0	1	01	01	H0332_009_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	009	0	1	01	01	H0332_009_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0336	001	0	1	48	05	H0336_001_0	3	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	3	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	3	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	3	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					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	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					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	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H0342	001	0	1	04	01	H0342_001_0	6	Vaccines	4	11	1	2	6	1		111	01			1				30	60	90	1	2							30		31								0.00	0.00	0.00					0.00	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	7	Preferred Generic	4	11	3	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	4.00	6.00				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, Select Diabetic Drugs												
H0351	038	0	1	01	01	H0351_038_0	7	Preferred Generic	4	11	3	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	4.00	6.00				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, Select Diabetic Drugs										2	2	3
H0351	038	0	1	01	01	H0351_038_0	7	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	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, Select Diabetic Drugs												
H0351	038	0	1	01	01	H0351_038_0	7	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	15.00											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, Select Diabetic Drugs										1		
H0351	038	0	1	01	01	H0351_038_0	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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 Diabetic Drugs												
H0351	038	0	1	01	01	H0351_038_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Diabetic Drugs												
H0351	038	0	1	01	01	H0351_038_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0351	038	0	1	01	01	H0351_038_0	7	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H0351	038	0	1	01	01	H0351_038_0	7	Select Diabetic Drugs	4	10	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 Diabetic Drugs										2		
H0351	052	0	1	01	01	H0351_052_0	5	Preferred Generic	4	11	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, Select Care Drugs												
H0351	052	0	1	01	01	H0351_052_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	052	0	1	01	01	H0351_052_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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												
H0351	052	0	1	01	01	H0351_052_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0351	052	0	1	01	01	H0351_052_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	052	0	1	01	01	H0351_052_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	052	0	1	01	01	H0351_052_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0351	053	0	1	01	01	H0351_053_0	4	Preferred Generic	4	11	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											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, Select Care Drugs												
H0351	053	0	1	01	01	H0351_053_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	053	0	1	01	01	H0351_053_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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												
H0351	053	0	1	01	01	H0351_053_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0351	053	0	1	01	01	H0351_053_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	053	0	1	01	01	H0351_053_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	053	0	1	01	01	H0351_053_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0351	054	0	1	01	01	H0351_054_0	4	Preferred Generic	4	11	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											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, Select Care Drugs												
H0351	054	0	1	01	01	H0351_054_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	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	Preferred Brand	4	11	1	2	3	1		111	01		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												
H0351	054	0	1	01	01	H0351_054_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0351	054	0	1	01	01	H0351_054_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	054	0	1	01	01	H0351_054_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	055	0	1	01	01	H0351_055_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	055	0	1	01	01	H0351_055_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	055	0	1	01	01	H0351_055_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	055	0	1	01	01	H0351_055_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				96.95	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	055	0	1	01	01	H0351_055_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	055	0	1	01	01	H0351_055_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	056	0	1	01	01	H0351_056_0	4	Preferred Generic	4	11	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, Select Care Drugs												
H0351	056	0	1	01	01	H0351_056_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	056	0	1	01	01	H0351_056_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0351	056	0	1	01	01	H0351_056_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0351	056	0	1	01	01	H0351_056_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	056	0	1	01	01	H0351_056_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	057	0	1	01	01	H0351_057_0	4	Preferred Generic	4	11	3	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	4.00	6.00				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, Select Diabetic Drugs												
H0351	057	0	1	01	01	H0351_057_0	4	Preferred Generic	4	11	3	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	4.00	6.00				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, Select Diabetic Drugs										2	2	3
H0351	057	0	1	01	01	H0351_057_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	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 Diabetic Drugs												
H0351	057	0	1	01	01	H0351_057_0	4	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	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 Diabetic Drugs										1		
H0351	057	0	1	01	01	H0351_057_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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 Diabetic Drugs												
H0351	057	0	1	01	01	H0351_057_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Diabetic Drugs												
H0351	057	0	1	01	01	H0351_057_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0351	057	0	1	01	01	H0351_057_0	4	Select Diabetic Drugs	4	10	1	2	6	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	22.00	33.00				11.00	22.00	22.00				11.00				11.00			0.37	0.37		0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0351	057	0	1	01	01	H0351_057_0	4	Select Diabetic Drugs	4	10	1	2	6	3		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	22.00	33.00				11.00	22.00	22.00				11.00				11.00			0.37	0.37		0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2		
H0354	001	0	1	01	01	H0354_001_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	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	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				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												
H0354	001	0	1	01	01	H0354_001_0	5	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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0354	001	0	1	01	01	H0354_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											848.14	33						735.30	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	Preferred Generic	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	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	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				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												
H0354	024	0	1	01	01	H0354_024_0	5	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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0354	024	0	1	01	01	H0354_024_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											522.02	33						879.02	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	Preferred Generic	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	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	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				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												
H0354	027	0	1	01	01	H0354_027_0	5	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					5.00	10.00	10.00											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 Diabetic Drugs										1		
H0354	027	0	1	01	01	H0354_027_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											793.49	33						695.72	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	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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	10.00											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												
H0354	028	0	1	01	01	H0354_028_0	5	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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0354	028	0	1	01	01	H0354_028_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											819.08	33						679.01	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	001	0	1	02	01	H0422_001_0	10	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								12.00	24.00	36.00					3.00	6.00	9.00											12.00	24.00	36.00				3.00	6.00	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	10	Generic	4	11	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	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												
H0422	001	0	1	02	01	H0422_001_0	10	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					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	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	001	0	1	02	01	H0422_001_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											54.00	50	50	50				54.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	001	0	1	02	01	H0422_001_0	10	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											1663.00	25	25	25				1663.00	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	003	0	1	02	01	H0422_003_0	10	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								12.00	24.00	36.00					3.00	6.00	9.00											12.00	24.00	36.00				3.00	6.00	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	003	0	1	02	01	H0422_003_0	10	Generic	4	11	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	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												
H0422	003	0	1	02	01	H0422_003_0	10	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											120.00	25	25	25				81.00	17	17	17										25	25	25				17	17	17				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	003	0	1	02	01	H0422_003_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											59.00	50	50	50				59.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	003	0	1	02	01	H0422_003_0	10	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2383.00	25	25	25				2383.00	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	003	0	1	01	01	H0432_003_0	5	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												
H0432	003	0	1	01	01	H0432_003_0	5	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		
H0432	003	0	1	01	01	H0432_003_0	5	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	003	0	1	01	01	H0432_003_0	5	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0432	003	0	1	01	01	H0432_003_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												
H0432	003	0	1	01	01	H0432_003_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												
H0432	003	0	1	01	01	H0432_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				459.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	004	0	1	01	01	H0432_004_0	5	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												
H0432	004	0	1	01	01	H0432_004_0	5	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		
H0432	004	0	1	01	01	H0432_004_0	5	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				484.00	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	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	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		
H0432	010	0	1	01	01	H0432_010_0	5	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											420.00	32						430.00	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	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											97.98	37	37	37				92.51	37	37	37										37	37	37				37	37	37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											706.86	28						586.52	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											97.98	37	37	37				92.51	37	37	37										37	37	37				37	37	37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											706.86	28						586.52	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	006	0	1	01	01	H0439_006_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	01	01	H0439_006_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					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	01	01	H0439_006_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	006	0	1	01	01	H0439_006_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	006	0	1	01	01	H0439_006_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											844.41	33						666.77	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	007	0	1	01	01	H0439_007_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	007	0	1	01	01	H0439_007_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	007	0	1	01	01	H0439_007_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											911.06	33						794.84	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	008	0	1	01	01	H0439_008_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	008	0	1	01	01	H0439_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	008	0	1	01	01	H0439_008_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											903.85	31						686.99	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	009	0	1	01	01	H0439_009_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	009	0	1	01	01	H0439_009_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	009	0	1	01	01	H0439_009_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											750.44	33						806.58	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	010	0	1	01	01	H0439_010_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	010	0	1	01	01	H0439_010_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	010	0	1	01	01	H0439_010_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											767.47	31						643.75	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	011	0	1	01	01	H0439_011_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	011	0	1	01	01	H0439_011_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	011	0	1	01	01	H0439_011_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											913.89	33						723.43	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_001_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_001_0	4	Preferred Generic	4	11	1	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		
H0473	001	0	1	04	01	H0473_001_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_001_0	4	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		
H0473	001	0	1	04	01	H0473_001_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	003	0	1	04	01	H0473_003_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	003	0	1	04	01	H0473_003_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	003	0	1	04	01	H0473_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												
H0473	003	0	1	04	01	H0473_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												
H0473	003	0	1	04	01	H0473_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	004	0	1	04	01	H0473_004_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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
H0473	004	0	1	04	01	H0473_004_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	004	0	1	04	01	H0473_004_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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		
H0473	004	0	1	04	01	H0473_004_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	004	0	1	04	01	H0473_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	004	0	1	04	01	H0473_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	005	0	1	04	01	H0473_005_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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
H0473	005	0	1	04	01	H0473_005_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	005	0	1	04	01	H0473_005_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0473	005	0	1	04	01	H0473_005_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	006	0	1	04	01	H0473_006_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	006	0	1	04	01	H0473_006_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	006	0	1	04	01	H0473_006_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	006	0	1	04	01	H0473_006_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	006	0	1	04	01	H0473_006_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0480	001	0	1	48	05	H0480_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			
H0480	001	0	1	48	05	H0480_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			
H0480	001	0	1	48	05	H0480_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			
H0482	001	0	1	01	01	H0482_001_0	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	001	0	1	01	01	H0482_001_0	6	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					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	0.00				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	001	0	1	01	01	H0482_001_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H0482	001	0	1	01	01	H0482_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0482	001	0	1	01	01	H0482_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	001	0	1	01	01	H0482_001_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	002	0	1	01	01	H0482_002_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0482	002	0	1	01	01	H0482_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	002	0	1	01	01	H0482_002_0	4	Generic	4	11	1	2	2	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											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0482	002	0	1	01	01	H0482_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H0482	002	0	1	01	01	H0482_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0482	002	0	1	01	01	H0482_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	002	0	1	01	01	H0482_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0482	003	0	1	01	01	H0482_003_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	003	0	1	01	01	H0482_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	0.00				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	003	0	1	01	01	H0482_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H0482	003	0	1	01	01	H0482_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0482	003	0	1	01	01	H0482_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, Select Care Drugs												
H0482	003	0	1	01	01	H0482_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	004	0	1	01	01	H0482_004_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	004	0	1	01	01	H0482_004_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0482	004	0	1	01	01	H0482_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	004	0	1	01	01	H0482_004_0	4	Generic	4	11	1	2	2	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											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0482	004	0	1	01	01	H0482_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H0482	004	0	1	01	01	H0482_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0482	004	0	1	01	01	H0482_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	004	0	1	01	01	H0482_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	004	0	1	01	01	H0482_004_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0482	005	0	1	01	01	H0482_005_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	005	0	1	01	01	H0482_005_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	005	0	1	01	01	H0482_005_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	46.00	92.00	138.00																									46.00	92.00	138.00				46.00	92.00	92.00				46.00				46.00		1.53				1.53	1.53	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	005	0	1	01	01	H0482_005_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.41	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	005	0	1	01	01	H0482_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	005	0	1	01	01	H0482_005_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		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	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	5	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	5	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	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	5	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	5	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	5	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	028	0	1	01	01	H0504_028_0	5	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	028	0	1	01	01	H0504_028_0	5	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					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	028	0	1	01	01	H0504_028_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	5	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	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	5	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	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	5	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	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1180.10	30						1180.10	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	038	0	1	01	01	H0504_038_0	5	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	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	038	0	1	01	01	H0504_038_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	038	0	1	01	01	H0504_038_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_0	5	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	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	5	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	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_0	5	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	5	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	5	Generic	4	01	3	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	5	Generic	4	01	3	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		3
H0504	040	0	1	01	01	H0504_040_0	5	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	041	0	1	01	01	H0504_041_0	5	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	5	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	5	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	041	0	1	01	01	H0504_041_0	5	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	041	0	1	01	01	H0504_041_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	041	0	1	01	01	H0504_041_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	043	0	1	01	01	H0504_043_0	5	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	5	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	5	Generic	4	01	3	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	5	Generic	4	01	3	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		3
H0504	043	0	1	01	01	H0504_043_0	5	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	043	0	1	01	01	H0504_043_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	045	0	1	01	01	H0504_045_0	5	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	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	045	0	1	01	01	H0504_045_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	045	0	1	01	01	H0504_045_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	046	0	1	01	01	H0504_046_0	5	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	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	046	0	1	01	01	H0504_046_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	046	0	1	01	01	H0504_046_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	047	0	1	01	01	H0504_047_0	7	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	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	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	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	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	Specialty Tier	4	11	1	1	5	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	048	0	1	01	01	H0504_048_0	7	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	048	0	1	01	01	H0504_048_0	7	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	048	0	1	01	01	H0504_048_0	7	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	048	0	1	01	01	H0504_048_0	7	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	048	0	1	01	01	H0504_048_0	7	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	048	0	1	01	01	H0504_048_0	7	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	048	0	1	01	01	H0504_048_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H0523	002	0	1	01	01	H0523_002_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											909.14	33						398.54	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	022	0	1	01	01	H0523_022_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	022	0	1	01	01	H0523_022_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H0523	022	0	1	01	01	H0523_022_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	022	0	1	01	01	H0523_022_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	022	0	1	01	01	H0523_022_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1061.12	33						340.15	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	031	0	1	01	01	H0523_031_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H0523	031	0	1	01	01	H0523_031_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											910.90	33						319.75	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	052	0	1	01	01	H0523_052_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	052	0	1	01	01	H0523_052_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H0523	052	0	1	01	01	H0523_052_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	052	0	1	01	01	H0523_052_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	052	0	1	01	01	H0523_052_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											836.91	33						350.84	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H0523	061	0	1	01	01	H0523_061_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											777.38	33						348.74	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0524	002	0	2	01	01	H0524_002_0	10	Preferred Generic	4	11	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	10	Preferred Generic	4	11	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	10	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	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	10	Preferred Generic	4	11	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	003	0	1	01	01	H0524_003_0	10	Preferred Generic	4	11	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	003	0	1	01	01	H0524_003_0	10	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	10	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	008	0	1	01	01	H0524_008_0	10	Preferred Generic	4	11	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	10	Preferred Generic	4	11	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	10	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	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	10	Preferred Generic	4	11	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	10	Preferred Generic	4	11	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	10	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	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	10	Preferred Generic	4	11	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	013	0	1	01	01	H0524_013_0	10	Preferred Generic	4	11	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	013	0	1	01	01	H0524_013_0	10	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	013	0	1	01	01	H0524_013_0	10	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	013	0	1	01	01	H0524_013_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	10	Preferred Generic	4	11	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	015	0	1	01	01	H0524_015_0	10	Preferred Generic	4	11	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	015	0	1	01	01	H0524_015_0	10	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	10	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_0	10	Preferred Generic	4	11	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	10	Preferred Generic	4	11	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	10	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	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	10	Preferred Generic	4	11	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	032	0	1	01	01	H0524_032_0	10	Preferred Generic	4	11	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	032	0	1	01	01	H0524_032_0	10	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	032	0	1	01	01	H0524_032_0	10	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	032	0	1	01	01	H0524_032_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	033	0	1	01	01	H0524_033_0	10	Preferred Generic	4	11	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	033	0	1	01	01	H0524_033_0	10	Preferred Generic	4	11	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	033	0	1	01	01	H0524_033_0	10	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	033	0	1	01	01	H0524_033_0	10	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	033	0	1	01	01	H0524_033_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	10	Preferred Generic	4	11	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	034	0	1	01	01	H0524_034_0	10	Preferred Generic	4	11	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	034	0	1	01	01	H0524_034_0	10	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	10	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	10	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	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	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	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	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	10	Preferred Generic	4	11	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	10	Preferred Generic	4	11	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	10	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	10	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	035	0	1	01	01	H0524_035_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	10	Preferred Generic	4	11	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	10	Preferred Generic	4	11	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	10	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	10	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	10	Preferred Generic	4	11	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	037	0	1	01	01	H0524_037_0	10	Preferred Generic	4	11	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	037	0	1	01	01	H0524_037_0	10	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	10	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	10	Preferred Generic	4	11	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	038	0	1	01	01	H0524_038_0	10	Preferred Generic	4	11	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	038	0	1	01	01	H0524_038_0	10	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	038	0	1	01	01	H0524_038_0	10	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	038	0	1	01	01	H0524_038_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	039	0	1	01	01	H0524_039_0	10	Preferred Generic	4	11	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	039	0	1	01	01	H0524_039_0	10	Preferred Generic	4	11	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	039	0	1	01	01	H0524_039_0	10	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	039	0	1	01	01	H0524_039_0	10	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	039	0	1	01	01	H0524_039_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	10	Preferred Generic	4	11	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	040	0	1	01	01	H0524_040_0	10	Preferred Generic	4	11	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	040	0	1	01	01	H0524_040_0	10	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	040	0	1	01	01	H0524_040_0	10	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	040	0	1	01	01	H0524_040_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	10	Preferred Generic	4	11	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	041	0	1	01	01	H0524_041_0	10	Preferred Generic	4	11	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	041	0	1	01	01	H0524_041_0	10	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	041	0	1	01	01	H0524_041_0	10	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	041	0	1	01	01	H0524_041_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	042	0	1	01	01	H0524_042_0	10	Preferred Generic	4	11	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	042	0	1	01	01	H0524_042_0	10	Preferred Generic	4	11	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	042	0	1	01	01	H0524_042_0	10	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	042	0	1	01	01	H0524_042_0	10	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	042	0	1	01	01	H0524_042_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	10	Preferred Generic	4	11	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	043	0	1	01	01	H0524_043_0	10	Preferred Generic	4	11	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	043	0	1	01	01	H0524_043_0	10	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	043	0	1	01	01	H0524_043_0	10	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	043	0	1	01	01	H0524_043_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	046	0	1	01	01	H0524_046_0	10	Preferred Generic	4	11	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	046	0	1	01	01	H0524_046_0	10	Preferred Generic	4	11	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	046	0	1	01	01	H0524_046_0	10	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	046	0	1	01	01	H0524_046_0	10	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	046	0	1	01	01	H0524_046_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	051	0	1	01	01	H0524_051_0	10	Preferred Generic	4	11	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	051	0	1	01	01	H0524_051_0	10	Preferred Generic	4	11	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	051	0	1	01	01	H0524_051_0	10	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	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	054	0	1	01	01	H0524_054_0	10	Preferred Generic	4	11	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	054	0	1	01	01	H0524_054_0	10	Preferred Generic	4	11	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	054	0	1	01	01	H0524_054_0	10	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	054	0	1	01	01	H0524_054_0	10	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	054	0	1	01	01	H0524_054_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	059	0	1	01	01	H0524_059_0	10	Preferred Generic	4	11	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	059	0	1	01	01	H0524_059_0	10	Preferred Generic	4	11	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	059	0	1	01	01	H0524_059_0	10	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	059	0	1	01	01	H0524_059_0	10	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	059	0	1	01	01	H0524_059_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	059	0	1	01	01	H0524_059_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	060	0	1	01	01	H0524_060_0	10	Preferred Generic	4	11	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	060	0	1	01	01	H0524_060_0	10	Preferred Generic	4	11	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	060	0	1	01	01	H0524_060_0	10	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	060	0	1	01	01	H0524_060_0	10	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	060	0	1	01	01	H0524_060_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	060	0	1	01	01	H0524_060_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	061	0	1	01	01	H0524_061_0	10	Preferred Generic	4	11	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	061	0	1	01	01	H0524_061_0	10	Preferred Generic	4	11	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	061	0	1	01	01	H0524_061_0	10	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	061	0	1	01	01	H0524_061_0	10	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	061	0	1	01	01	H0524_061_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	061	0	1	01	01	H0524_061_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	062	0	1	01	01	H0524_062_0	10	Preferred Generic	4	11	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	062	0	1	01	01	H0524_062_0	10	Preferred Generic	4	11	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	062	0	1	01	01	H0524_062_0	10	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	062	0	1	01	01	H0524_062_0	10	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	062	0	1	01	01	H0524_062_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					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	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	062	0	1	01	01	H0524_062_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	063	0	1	01	01	H0524_063_0	10	Preferred Generic	4	11	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	063	0	1	01	01	H0524_063_0	10	Preferred Generic	4	11	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	063	0	1	01	01	H0524_063_0	10	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	063	0	1	01	01	H0524_063_0	10	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	063	0	1	01	01	H0524_063_0	10	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	063	0	1	01	01	H0524_063_0	10	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	063	0	1	01	01	H0524_063_0	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	063	0	1	01	01	H0524_063_0	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	063	0	1	01	01	H0524_063_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	064	0	1	01	01	H0524_064_0	10	Preferred Generic	4	11	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	064	0	1	01	01	H0524_064_0	10	Preferred Generic	4	11	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	064	0	1	01	01	H0524_064_0	10	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	064	0	1	01	01	H0524_064_0	10	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	064	0	1	01	01	H0524_064_0	10	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	064	0	1	01	01	H0524_064_0	10	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	064	0	1	01	01	H0524_064_0	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	064	0	1	01	01	H0524_064_0	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	064	0	1	01	01	H0524_064_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	065	0	1	01	01	H0524_065_0	10	Preferred Generic	4	11	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	065	0	1	01	01	H0524_065_0	10	Preferred Generic	4	11	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	065	0	1	01	01	H0524_065_0	10	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	065	0	1	01	01	H0524_065_0	10	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	065	0	1	01	01	H0524_065_0	10	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	065	0	1	01	01	H0524_065_0	10	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	065	0	1	01	01	H0524_065_0	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	065	0	1	01	01	H0524_065_0	10	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	065	0	1	01	01	H0524_065_0	10	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0543	001	0	1	01	01	H0543_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	001	0	1	01	01	H0543_001_0	3	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	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	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	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	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	013	0	1	01	01	H0543_013_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	3	Preferred Generic	4	01	1	2	1	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	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	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	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	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	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												
H0543	019	0	1	01	01	H0543_019_0	3	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	019	0	1	01	01	H0543_019_0	3	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	019	0	1	01	01	H0543_019_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				493.00	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	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				439.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	2	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												
H0543	028	0	1	01	01	H0543_028_0	2	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	028	0	1	01	01	H0543_028_0	2	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2	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	028	0	1	01	01	H0543_028_0	2	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	028	0	1	01	01	H0543_028_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				315.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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												
H0543	029	0	1	01	01	H0543_029_0	2	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	029	0	1	01	01	H0543_029_0	2	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	2	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2	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	029	0	1	01	01	H0543_029_0	2	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	029	0	1	01	01	H0543_029_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				210.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				125.00	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	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	035	0	1	01	01	H0543_035_0	3	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	035	0	1	01	01	H0543_035_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	035	0	1	01	01	H0543_035_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				457.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	2	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												
H0543	036	0	1	01	01	H0543_036_0	2	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	036	0	1	01	01	H0543_036_0	2	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2	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	036	0	1	01	01	H0543_036_0	2	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	036	0	1	01	01	H0543_036_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				281.00	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	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	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	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	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	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	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	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												
H0543	070	0	1	01	01	H0543_070_0	2	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												
H0543	070	0	1	01	01	H0543_070_0	2	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	070	0	1	01	01	H0543_070_0	2	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	2	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2	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	070	0	1	01	01	H0543_070_0	2	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	070	0	1	01	01	H0543_070_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				346.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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												
H0543	086	0	1	01	01	H0543_086_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	086	0	1	01	01	H0543_086_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	086	0	1	01	01	H0543_086_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	3	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												
H0543	089	0	1	01	01	H0543_089_0	6	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	089	0	1	01	01	H0543_089_0	6	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	089	0	1	01	01	H0543_089_0	6	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	6	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	6	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												
H0543	089	0	1	01	01	H0543_089_0	6	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	089	0	1	01	01	H0543_089_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				437.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	7	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	7	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				350.00	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	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												
H0543	140	0	1	01	01	H0543_140_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	140	0	1	01	01	H0543_140_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	140	0	1	01	01	H0543_140_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				558.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	4	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	4	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	4	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	4	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	4	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												
H0543	145	0	1	01	01	H0543_145_0	4	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	4	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	4	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	4	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	4	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	146	0	1	01	01	H0543_146_0	4	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	146	0	1	01	01	H0543_146_0	4	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	146	0	1	01	01	H0543_146_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				348.00	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	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												
H0543	147	0	1	01	01	H0543_147_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	147	0	1	01	01	H0543_147_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	147	0	1	01	01	H0543_147_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				390.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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	148	0	1	01	01	H0543_148_0	4	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	148	0	1	01	01	H0543_148_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	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												
H0543	151	0	1	01	01	H0543_151_0	4	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	4	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	4	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	4	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	151	0	1	01	01	H0543_151_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	35.00		105.00																											105.00						95.00				35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	4	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												
H0543	152	0	1	01	01	H0543_152_0	4	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	4	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	4	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	4	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				413.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	163	0	1	01	01	H0543_163_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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												
H0543	163	0	1	01	01	H0543_163_0	4	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	163	0	1	01	01	H0543_163_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	163	0	1	01	01	H0543_163_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	163	0	1	01	01	H0543_163_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				270.00	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	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				420.00	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	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	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	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	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	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	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	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												
H0543	166	0	1	01	01	H0543_166_0	3	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				382.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	167	0	1	01	01	H0543_167_0	4	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	4	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	4	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	4	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	167	0	1	01	01	H0543_167_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	167	0	1	01	01	H0543_167_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				276.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	168	0	1	01	01	H0543_168_0	4	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	4	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	4	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	4	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	35.00		105.00																											105.00						95.00				35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	168	0	1	01	01	H0543_168_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				432.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	169	0	1	01	01	H0543_169_0	4	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	4	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	4	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	4	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	35.00		105.00																											105.00						95.00				35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	169	0	1	01	01	H0543_169_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	4	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	170	0	1	01	01	H0543_170_0	4	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	4	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	4	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	4	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	35.00		105.00																											105.00						95.00				35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	170	0	1	01	01	H0543_170_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	4	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												
H0543	176	0	1	01	01	H0543_176_0	4	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	176	0	1	01	01	H0543_176_0	4	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	176	0	1	01	01	H0543_176_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	01	01	H0543_176_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	01	01	H0543_176_0	4	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												
H0543	177	0	1	01	01	H0543_177_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	01	01	H0543_177_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	177	0	1	01	01	H0543_177_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	177	0	1	01	01	H0543_177_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	01	01	H0543_177_0	3	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												
H0543	178	0	1	01	01	H0543_178_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	01	01	H0543_178_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	178	0	1	01	01	H0543_178_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	178	0	1	01	01	H0543_178_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	01	01	H0543_178_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				304.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	01	01	H0543_179_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	01	01	H0543_179_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	179	0	1	01	01	H0543_179_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	179	0	1	01	01	H0543_179_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	01	01	H0543_179_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				243.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	188	0	1	01	01	H0543_188_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	188	0	1	01	01	H0543_188_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	188	0	1	01	01	H0543_188_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	188	0	1	01	01	H0543_188_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	188	0	1	01	01	H0543_188_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				351.00	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	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												
H0543	189	0	1	01	01	H0543_189_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	189	0	1	01	01	H0543_189_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	189	0	1	01	01	H0543_189_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	189	0	1	01	01	H0543_189_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				350.00	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	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												
H0543	191	0	1	01	01	H0543_191_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	191	0	1	01	01	H0543_191_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	191	0	1	01	01	H0543_191_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	191	0	1	01	01	H0543_191_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				585.00	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	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	193	0	1	01	01	H0543_193_0	3	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	193	0	1	01	01	H0543_193_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	193	0	1	01	01	H0543_193_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	193	0	1	01	01	H0543_193_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				246.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	194	0	1	01	01	H0543_194_0	3	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	194	0	1	01	01	H0543_194_0	3	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	194	0	1	01	01	H0543_194_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	194	0	1	01	01	H0543_194_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	194	0	1	01	01	H0543_194_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				501.00	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	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												
H0543	195	0	1	01	01	H0543_195_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	195	0	1	01	01	H0543_195_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	195	0	1	01	01	H0543_195_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	195	0	1	01	01	H0543_195_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				359.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	196	0	1	01	01	H0543_196_0	3	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	196	0	1	01	01	H0543_196_0	3	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	196	0	1	01	01	H0543_196_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	196	0	1	01	01	H0543_196_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	196	0	1	01	01	H0543_196_0	3	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	204	0	1	01	01	H0543_204_0	4	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											587.00	33						511.00	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	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	205	0	1	01	01	H0543_205_0	3	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	205	0	1	01	01	H0543_205_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	205	0	1	01	01	H0543_205_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	205	0	1	01	01	H0543_205_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				316.00	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	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	209	0	1	01	01	H0543_209_0	3	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	209	0	1	01	01	H0543_209_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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	209	0	1	01	01	H0543_209_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	209	0	1	01	01	H0543_209_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				281.00	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	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	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	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	35.00		105.00																											105.00						95.00				35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	210	0	1	02	01	H0543_210_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	210	0	1	02	01	H0543_210_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				387.00	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	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	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	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	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	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	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	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												
H0543	215	0	1	02	01	H0543_215_0	3	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	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	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	35.00		105.00																											105.00						95.00				35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	215	0	1	02	01	H0543_215_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	215	0	1	02	01	H0543_215_0	3	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	216	0	1	02	01	H0543_216_0	3	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	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	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	35.00		105.00																											105.00						95.00				35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	216	0	1	02	01	H0543_216_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	216	0	1	02	01	H0543_216_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				392.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	217	0	1	01	01	H0543_217_0	3	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	217	0	1	01	01	H0543_217_0	3	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	217	0	1	01	01	H0543_217_0	3	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	217	0	1	01	01	H0543_217_0	3	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	217	0	1	01	01	H0543_217_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	35.00		105.00																											105.00						95.00				35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	217	0	1	01	01	H0543_217_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	217	0	1	01	01	H0543_217_0	3	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												
H0543	218	0	1	01	01	H0543_218_0	3	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	218	0	1	01	01	H0543_218_0	3	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	218	0	1	01	01	H0543_218_0	3	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	218	0	1	01	01	H0543_218_0	3	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	218	0	1	01	01	H0543_218_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	35.00		105.00																											105.00						95.00				35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	218	0	1	01	01	H0543_218_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	218	0	1	01	01	H0543_218_0	3	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												
H0543	219	0	1	01	01	H0543_219_0	3	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	219	0	1	01	01	H0543_219_0	3	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	219	0	1	01	01	H0543_219_0	3	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	219	0	1	01	01	H0543_219_0	3	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	219	0	1	01	01	H0543_219_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	35.00		105.00																											105.00						95.00				35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	219	0	1	01	01	H0543_219_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	219	0	1	01	01	H0543_219_0	3	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												
H0543	220	0	1	01	01	H0543_220_0	3	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	220	0	1	01	01	H0543_220_0	3	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	220	0	1	01	01	H0543_220_0	3	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	220	0	1	01	01	H0543_220_0	3	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	220	0	1	01	01	H0543_220_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	35.00		105.00																											105.00						95.00				35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	220	0	1	01	01	H0543_220_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	220	0	1	01	01	H0543_220_0	3	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	221	0	1	01	01	H0543_221_0	3	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	221	0	1	01	01	H0543_221_0	3	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	221	0	1	01	01	H0543_221_0	3	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	221	0	1	01	01	H0543_221_0	3	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	221	0	1	01	01	H0543_221_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	35.00		105.00																											105.00						95.00				35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	221	0	1	01	01	H0543_221_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	221	0	1	01	01	H0543_221_0	3	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												
H0543	222	0	1	01	01	H0543_222_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	222	0	1	01	01	H0543_222_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H0543	222	0	1	01	01	H0543_222_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	222	0	1	01	01	H0543_222_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	222	0	1	01	01	H0543_222_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	222	0	1	01	01	H0543_222_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	222	0	1	01	01	H0543_222_0	3	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	223	0	1	01	01	H0543_223_0	3	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	223	0	1	01	01	H0543_223_0	3	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	223	0	1	01	01	H0543_223_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	223	0	1	01	01	H0543_223_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	223	0	1	01	01	H0543_223_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	223	0	1	01	01	H0543_223_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	223	0	1	01	01	H0543_223_0	3	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	224	0	1	01	01	H0543_224_0	3	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	224	0	1	01	01	H0543_224_0	3	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	224	0	1	01	01	H0543_224_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	224	0	1	01	01	H0543_224_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	224	0	1	01	01	H0543_224_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	224	0	1	01	01	H0543_224_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	224	0	1	01	01	H0543_224_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				331.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	002	0	1	01	01	H0544_002_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	8	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_0	8	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	28.50					0.00	0.00	0.00																9.50				9.50			0.32	0.32	0.00			0.28	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	8	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								9.50	19.00	28.50					9.50	19.00	28.50					0.00	0.00	0.00																9.50				9.50			0.32	0.32	0.00			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	8	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	112.50					37.50	75.00	75.00																37.50				37.50			1.25	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	8	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	002	0	1	01	01	H0544_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	8	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	002	0	1	01	01	H0544_002_0	8	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		
H0544	003	0	1	01	01	H0544_003_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_003_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	7	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_003_0	7	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											50.00	25	25	25				50.00	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											100.00	25	25	25				100.00	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	7	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	003	0	1	01	01	H0544_003_0	7	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		
H0544	004	0	1	01	01	H0544_004_0	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_0	9	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	22.50					0.00	0.00	0.00																7.50				7.50			0.25	0.25	0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	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	22.50					0.00	0.00	0.00																7.50				7.50			0.25	0.25	0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_0	9	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H0544	004	0	1	01	01	H0544_004_0	9	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	004	0	1	01	01	H0544_004_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	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	004	0	1	01	01	H0544_004_0	9	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		
H0544	005	0	1	01	01	H0544_005_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	8	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	8	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																			0.00	0.00	0.00																9.50				9.50		0.32			0.00			0.28	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	8	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																			0.00	0.00	0.00																9.50				9.50		0.32			0.00			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	8	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	8	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	8	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	8	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	8	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	10	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	15.00					0.00	0.00	0.00																5.00				5.00			0.17	0.17	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	10	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	43.50					0.00	0.00	0.00																14.50				14.50			0.48	0.48	0.00			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	10	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	135.00					45.00	90.00	90.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	10	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												
H0544	007	0	1	01	01	H0544_007_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	10	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	008	0	1	01	01	H0544_008_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					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	8	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	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	008	0	1	01	01	H0544_008_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	8	Generic	4	01	1	2	2	3		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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			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	8	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	8	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H0544	010	0	1	01	01	H0544_010_0	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	8	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	8	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	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	8	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_0	8	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	22.50					0.00	0.00	0.00																7.50				7.50			0.25	0.25	0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	8	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.50	15.00	22.50					7.50	15.00	22.50					0.00	0.00	0.00																7.50				7.50			0.25	0.25	0.00			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								37.50	75.00	112.50					37.50	75.00	112.50					37.50	75.00	75.00																37.50				37.50			1.25	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	8	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	013	0	1	01	01	H0544_013_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	8	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	013	0	1	01	01	H0544_013_0	8	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		
H0544	014	0	1	01	01	H0544_014_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	8	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	8	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	22.50					0.00	0.00	0.00																7.50				7.50			0.25	0.25	0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	8	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.50	15.00	22.50					7.50	15.00	22.50					0.00	0.00	0.00																7.50				7.50			0.25	0.25	0.00			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								37.50	75.00	112.50					37.50	75.00	112.50					37.50	75.00	75.00																37.50				37.50			1.25	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	8	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	014	0	1	01	01	H0544_014_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	8	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	014	0	1	01	01	H0544_014_0	8	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		
H0544	015	0	1	01	01	H0544_015_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	8	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	22.50					0.00	0.00	0.00																7.50				7.50			0.25	0.25	0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8	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	22.50					0.00	0.00	0.00																7.50				7.50			0.25	0.25	0.00			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	8	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	112.50					37.50	75.00	75.00																37.50				37.50			1.25	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	8	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	015	0	1	01	01	H0544_015_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8	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	015	0	1	01	01	H0544_015_0	8	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		
H0544	019	0	1	01	01	H0544_019_0	8	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	8	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	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	8	Generic	4	01	1	2	2	3		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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_0	8	Preferred Brand	4	11	1	2	3	1		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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	8	Generic	4	01	1	2	2	3		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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	027	0	1	01	01	H0544_027_0	8	Preferred Brand	4	11	1	2	3	1		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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			.42	.25	0.00			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	8	Generic	4	01	1	2	2	3		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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	8	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	8	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	7	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	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	032	0	1	01	01	H0544_032_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H0544	032	0	1	01	01	H0544_032_0	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	7	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	7	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			.42	.25	0.00			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	8	Generic	4	01	1	2	2	3		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					0.00	0.00	0.00																12.50				12.50			.42	.25	0.00			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	036	0	1	01	01	H0544_036_0	8	Preferred Brand	4	11	1	2	3	1		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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	8	Generic	4	01	1	2	2	3		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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	038	0	1	01	01	H0544_038_0	8	Preferred Brand	4	11	1	2	3	1		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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	8	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	8	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	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	8	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	8	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	8	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	8	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	8	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	8	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	8	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	8	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	10	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	10	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	10	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					0.00	0.00	0.00																15.00				15.00			0.50	0.50	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	052	0	1	01	01	H0544_052_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	053	0	1	01	01	H0544_053_0	8	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	8	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	8	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					0.00	0.00	0.00																15.00				15.00			0.50	0.50	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	053	0	1	01	01	H0544_053_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	054	0	1	01	01	H0544_054_0	6	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			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	6	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0544	054	0	1	01	01	H0544_054_0	6	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					0.00	0.00	0.00																9.00				9.00			0.30	0.30	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	054	0	1	01	01	H0544_054_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	054	0	1	01	01	H0544_054_0	6	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	6	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	6	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	6	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	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.50	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	055	0	1	01	01	H0544_055_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	056	0	1	01	01	H0544_056_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	058	0	1	01	01	H0544_058_0	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	061	0	1	01	01	H0544_061_0	6	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	6	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	6	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	061	0	1	01	01	H0544_061_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	062	0	1	01	01	H0544_062_0	6	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	6	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	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	062	0	1	01	01	H0544_062_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	063	0	1	01	01	H0544_063_0	6	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	6	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	6	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					0.00	0.00	0.00																14.00				14.00			0.47	0.17	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	063	0	1	01	01	H0544_063_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	064	0	1	01	01	H0544_064_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	6	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					0.00	0.00	0.00																12.00				12.00			0.40	0.23	0.00			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	069	0	1	01	01	H0544_069_0	6	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	6	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	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	069	0	1	01	01	H0544_069_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	070	0	1	01	01	H0544_070_0	6	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	6	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	6	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					0.00	0.00	0.00																9.00				9.00			0.30	0.30	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	070	0	1	01	01	H0544_070_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	071	0	1	01	01	H0544_071_0	6	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	6	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	6	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					0.00	0.00	0.00																12.00				12.00			0.40	0.40	0.00			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	071	0	1	01	01	H0544_071_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	072	0	1	01	01	H0544_072_0	6	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	6	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	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.50	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	072	0	1	01	01	H0544_072_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	081	0	1	01	01	H0544_081_0	6	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	6	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	6	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					0.00	0.00	0.00																2.00				2.00			0.07	0.07	0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	081	0	1	01	01	H0544_081_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	087	0	1	01	01	H0544_087_0	7	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	7	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	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.50	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	087	0	1	01	01	H0544_087_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	088	0	1	01	01	H0544_088_0	6	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	6	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	6	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					0.00	0.00	0.00																14.00				14.00			0.47	0.47	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	088	0	1	01	01	H0544_088_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	089	0	1	01	01	H0544_089_0	6	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	6	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	6	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					0.00	0.00	0.00																14.00				14.00			0.47	0.47	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	089	0	1	01	01	H0544_089_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	090	0	1	01	01	H0544_090_0	6	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	6	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	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.50	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	090	0	1	01	01	H0544_090_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	6	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	6	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	6	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					0.00	0.00	0.00																12.00				12.00			0.40	0.23	0.00			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	093	0	1	01	01	H0544_093_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	093	0	1	01	01	H0544_093_0	8	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	8	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	093	0	1	01	01	H0544_093_0	8	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	094	0	1	01	01	H0544_094_0	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			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	8	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	094	0	1	01	01	H0544_094_0	8	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H0544	094	0	1	01	01	H0544_094_0	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	094	0	1	01	01	H0544_094_0	8	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	8	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H0544	095	0	1	01	01	H0544_095_0	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	095	0	1	01	01	H0544_095_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	095	0	1	01	01	H0544_095_0	6	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	6	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	6	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	6	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	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	096	0	1	01	01	H0544_096_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	097	0	1	01	01	H0544_097_0	6	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	6	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	6	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					0.00	0.00	0.00																13.00				13.00			0.43	0.27	0.00			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	097	0	1	01	01	H0544_097_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	098	0	1	01	01	H0544_098_0	6	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	6	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	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	098	0	1	01	01	H0544_098_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	099	0	1	01	01	H0544_099_0	8	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	8	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	8	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					0.00	0.00	0.00																13.00				13.00			0.43	0.43	0.00			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	099	0	1	01	01	H0544_099_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	100	0	1	01	01	H0544_100_0	6	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			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	6	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0544	100	0	1	01	01	H0544_100_0	6	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					0.00	0.00	0.00																8.00				8.00			0.27	0.27	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	100	0	1	01	01	H0544_100_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	100	0	1	01	01	H0544_100_0	6	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	6	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	101	0	1	01	01	H0544_101_0	8	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					0.00	0.00	0.00																12.50				12.50			.42	.25	0.00			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	101	0	1	01	01	H0544_101_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	101	0	1	01	01	H0544_101_0	8	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	8	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	102	0	1	01	01	H0544_102_0	7	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	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	102	0	1	01	01	H0544_102_0	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	102	0	1	01	01	H0544_102_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	102	0	1	01	01	H0544_102_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H0544	102	0	1	01	01	H0544_102_0	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	102	0	1	01	01	H0544_102_0	7	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	7	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			.42	.25	0.00			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	103	0	1	01	01	H0544_103_0	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	103	0	1	01	01	H0544_103_0	8	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	8	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	104	0	1	01	01	H0544_104_0	7	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	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	104	0	1	01	01	H0544_104_0	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	104	0	1	01	01	H0544_104_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	104	0	1	01	01	H0544_104_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H0544	104	0	1	01	01	H0544_104_0	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	104	0	1	01	01	H0544_104_0	7	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	7	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			.42	.25	0.00			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	105	0	1	01	01	H0544_105_0	8	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					0.00	0.00	0.00																12.50				12.50			.42	.25	0.00			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	105	0	1	01	01	H0544_105_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	105	0	1	01	01	H0544_105_0	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	106	0	1	01	01	H0544_106_0	8	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					0.00	0.00	0.00																12.50				12.50			.42	.25	0.00			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	106	0	1	01	01	H0544_106_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	106	0	1	01	01	H0544_106_0	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	107	0	1	01	01	H0544_107_0	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	107	0	1	01	01	H0544_107_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	107	0	1	01	01	H0544_107_0	8	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	8	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	6	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	6	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	6	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	108	0	1	01	01	H0544_108_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	110	0	1	01	01	H0544_110_0	6	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	6	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	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.50	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	110	0	1	01	01	H0544_110_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	117	1	1	01	01	H0544_117_1	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	7	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	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	117	1	1	01	01	H0544_117_1	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	7	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	7	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	7	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	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	117	2	1	01	01	H0544_117_2	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	7	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	7	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	7	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	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	118	1	1	01	01	H0544_118_1	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H0544	118	1	1	01	01	H0544_118_1	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	7	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	7	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	7	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	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	118	2	1	01	01	H0544_118_2	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H0544	118	2	1	01	01	H0544_118_2	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	7	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	7	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	1	1	01	01	H0544_119_1	8	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					0.00	0.00	0.00																12.50				12.50			.42	.25	0.00			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	119	1	1	01	01	H0544_119_1	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	1	1	01	01	H0544_119_1	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	2	1	01	01	H0544_119_2	8	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					0.00	0.00	0.00																12.50				12.50			.42	.25	0.00			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	119	2	1	01	01	H0544_119_2	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	2	1	01	01	H0544_119_2	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	1	1	01	01	H0544_120_1	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	1	1	01	01	H0544_120_1	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	2	1	01	01	H0544_120_2	8	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	2	1	01	01	H0544_120_2	8	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	8	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	10	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					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, Select Care Drugs												
H0544	121	1	1	01	01	H0544_121_1	10	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					0.00	0.00	0.00																17.50				17.50			0.58	0.42	0.00			0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	1	1	01	01	H0544_121_1	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	1	1	01	01	H0544_121_1	10	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	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H0544	121	2	1	01	01	H0544_121_2	8	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					0.00	0.00	0.00																17.50				17.50			0.58	0.42	0.00			0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	2	1	01	01	H0544_121_2	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	2	1	01	01	H0544_121_2	8	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	125	0	1	01	01	H0544_125_0	6	Preferred Generic	4	01	1	2	1	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	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												
H0544	125	0	1	01	01	H0544_125_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	2	2	30	60	100				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	125	0	1	01	01	H0544_125_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	2	2	30	60	100				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	125	0	1	01	01	H0544_125_0	6	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	125	0	1	01	01	H0544_125_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34											50.00	26						50.00	26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	126	0	1	01	01	H0544_126_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	126	0	1	01	01	H0544_126_0	6	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	126	0	1	01	01	H0544_126_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	126	0	1	01	01	H0544_126_0	6	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	126	0	1	01	01	H0544_126_0	6	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											75.34	25	25	25				94.17	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	126	0	1	01	01	H0544_126_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											72.68	25	25	25				72.68	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	126	0	1	01	01	H0544_126_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	126	0	1	01	01	H0544_126_0	6	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	126	0	1	01	01	H0544_126_0	6	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		
H0544	127	0	1	01	01	H0544_127_0	6	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	127	0	1	01	01	H0544_127_0	6	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	127	0	1	01	01	H0544_127_0	6	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	127	0	1	01	01	H0544_127_0	6	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	127	0	1	01	01	H0544_127_0	6	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	127	0	1	01	01	H0544_127_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	128	0	1	01	01	H0544_128_0	10	Preferred Generic	4	01	1	1	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											2.19	25	25	25				2.19	25	25	25				0	0	0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	128	0	1	01	01	H0544_128_0	10	Generic	4	01	1	1	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											6.00	25	25	25				6.00	25	25	25				0	0	0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	128	0	1	01	01	H0544_128_0	10	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											93.49	25	25	25				93.49	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	128	0	1	01	01	H0544_128_0	10	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	128	0	1	01	01	H0544_128_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	128	0	1	01	01	H0544_128_0	10	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	128	0	1	01	01	H0544_128_0	10	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		
H0544	129	0	1	01	01	H0544_129_0	7	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	129	0	1	01	01	H0544_129_0	7	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	129	0	1	01	01	H0544_129_0	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.50	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	129	0	1	01	01	H0544_129_0	7	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	129	0	1	01	01	H0544_129_0	7	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	129	0	1	01	01	H0544_129_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	130	0	1	01	01	H0544_130_0	7	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	130	0	1	01	01	H0544_130_0	7	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	130	0	1	01	01	H0544_130_0	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.50	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	130	0	1	01	01	H0544_130_0	7	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	130	0	1	01	01	H0544_130_0	7	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	130	0	1	01	01	H0544_130_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0545	001	0	1	01	01	H0545_001_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	1			90				30		31	0.00		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	5	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	5	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	5	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	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0545	001	0	1	01	01	H0545_001_0	5	Non-Preferred Drug	4	11	3	1	4	1	110		01	100		1	30		90				2	1			90				30		31				40.01	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	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1121.12	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	Non-Preferred Drug	4	11	3	1	4	1	110		01	100		1	30		90				2	1			90				30		31				54.79	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				976.03	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	5	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	5	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	4	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	4	Generic	2	01	1	1	2	1	110		01	100		1	30		90				2	1			90				30		31				6.84	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0545	015	0	1	01	01	H0545_015_0	4	Preferred Brand	2	10	1	1	3	1	110		01	100		1	30		90				2	1			90				30		31				113.01	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0545	015	0	1	01	01	H0545_015_0	4	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	1			90				30		31				118.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0545	015	0	1	01	01	H0545_015_0	4	Specialty Tier	2	11	1	1	5	1	010		01			1	30														30		31				675.96	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	009	0	1	01	01	H0562_009_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					5.00	10.00	15.00											18.00	36.00	54.00				5.00	10.00	0.00				18.00				18.00			0.6	0.17		0.6	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0562	009	0	1	01	01	H0562_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	4	Preferred Generic	4	11	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											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, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0562	012	0	1	01	01	H0562_012_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					10.00	20.00	30.00											19.00	38.00	57.00				10.00	20.00	0.00				19.00				19.00			0.63	0.33		0.63	0.33	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0562	039	0	1	01	01	H0562_039_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					13.00	26.00	39.00											20.00	40.00	60.00				13.00	26.00	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, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0562	079	0	1	01	01	H0562_079_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	Preferred Generic	4	11	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											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					11.00	22.00	33.00											18.00	36.00	54.00				11.00	22.00	0.00				18.00				18.00			0.6	0.37		0.6	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0562	084	0	1	01	01	H0562_084_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	4	Preferred Generic	4	11	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, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H0562	090	0	1	01	01	H0562_090_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Preferred Generic	4	11	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											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, Select Diabetic Drugs												
H0562	092	0	1	01	01	H0562_092_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					8.00	16.00	24.00											15.00	30.00	45.00				8.00	16.00	0.00				15.00				15.00			0.5	0.27		0.5	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	092	0	1	01	01	H0562_092_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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 Diabetic Drugs												
H0562	092	0	1	01	01	H0562_092_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Diabetic Drugs												
H0562	092	0	1	01	01	H0562_092_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	092	0	1	01	01	H0562_092_0	4	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H0562	097	0	1	01	01	H0562_097_0	4	Preferred Generic	4	11	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											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												
H0562	097	0	1	01	01	H0562_097_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	0.00				15.00				15.00			0.5	0.1		0.5	0.1	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0562	097	0	1	01	01	H0562_097_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	Preferred Generic	4	11	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											13.00	26.00	39.00				0.00	0.00	0.00				13.00				13.00			0.43	0.00		0.43	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	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0562	103	0	1	01	01	H0562_103_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	4	Preferred Generic	4	11	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											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												
H0562	113	0	1	01	01	H0562_113_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	0.00				15.00				15.00			0.5	0.17		0.5	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0562	113	0	1	01	01	H0562_113_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	114	0	1	01	01	H0562_114_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	114	0	1	01	01	H0562_114_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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 Diabetic Drugs												
H0562	114	0	1	01	01	H0562_114_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Diabetic Drugs												
H0562	114	0	1	01	01	H0562_114_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	114	0	1	01	01	H0562_114_0	5	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H0562	118	0	1	01	01	H0562_118_0	4	Preferred Generic	4	11	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, Select Diabetic Drugs												
H0562	118	0	1	01	01	H0562_118_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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 Diabetic Drugs												
H0562	118	0	1	01	01	H0562_118_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					10.00	20.00	30.00											47.00	94.00	141.00				10.00	20.00	20.00				47.00				47.00			1.57	0.33		1.57	0.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	118	0	1	01	01	H0562_118_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					75.00	150.00	225.00											100.00	200.00	300.00				75.00	150.00	150.00				100.00				100.00			3.33	2.5		3.33	2.5	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	118	0	1	01	01	H0562_118_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	118	0	1	01	01	H0562_118_0	4	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H0562	120	0	1	01	01	H0562_120_0	4	Preferred Generic	4	11	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											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, Select Care Drugs												
H0562	120	0	1	01	01	H0562_120_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	120	0	1	01	01	H0562_120_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0562	120	0	1	01	01	H0562_120_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	120	0	1	01	01	H0562_120_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	120	0	1	01	01	H0562_120_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	121	0	1	01	01	H0562_121_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	121	0	1	01	01	H0562_121_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	121	0	1	01	01	H0562_121_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H0562	121	0	1	01	01	H0562_121_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.31	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	121	0	1	01	01	H0562_121_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	121	0	1	01	01	H0562_121_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	122	0	1	01	01	H0562_122_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	122	0	1	01	01	H0562_122_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	122	0	1	01	01	H0562_122_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H0562	122	0	1	01	01	H0562_122_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.59	46	46	46																								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	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	122	0	1	01	01	H0562_122_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	123	0	1	01	01	H0562_123_0	4	Preferred Generic	4	11	3	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			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	123	0	1	01	01	H0562_123_0	4	Preferred Generic	4	11	3	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, Select Care Drugs										1		3
H0562	123	0	1	01	01	H0562_123_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	123	0	1	01	01	H0562_123_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0562	123	0	1	01	01	H0562_123_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	123	0	1	01	01	H0562_123_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	123	0	1	01	01	H0562_123_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	123	0	1	01	01	H0562_123_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0562	124	0	1	01	01	H0562_124_0	4	Preferred Generic	4	11	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											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, Select Care Drugs												
H0562	124	0	1	01	01	H0562_124_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	124	0	1	01	01	H0562_124_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0562	124	0	1	01	01	H0562_124_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	124	0	1	01	01	H0562_124_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	124	0	1	01	01	H0562_124_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	125	0	1	01	01	H0562_125_0	4	Preferred Generic	4	11	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											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, Select Care Drugs												
H0562	125	0	1	01	01	H0562_125_0	4	Preferred Generic	4	11	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											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, Select Care Drugs										1		3
H0562	125	0	1	01	01	H0562_125_0	4	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					1.00	2.00	3.00											5.00	10.00	15.00				1.00	2.00	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, Select Care Drugs												
H0562	125	0	1	01	01	H0562_125_0	4	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	15.00					1.00	2.00	3.00											5.00	10.00	15.00				1.00	2.00	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, Select Care Drugs										1		
H0562	125	0	1	01	01	H0562_125_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0562	125	0	1	01	01	H0562_125_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	125	0	1	01	01	H0562_125_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	125	0	1	01	01	H0562_125_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	125	0	1	01	01	H0562_125_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0562	126	0	1	01	01	H0562_126_0	4	Preferred Generic	4	11	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											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, Select Care Drugs												
H0562	126	0	1	01	01	H0562_126_0	4	Preferred Generic	4	11	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											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, Select Care Drugs										1		3
H0562	126	0	1	01	01	H0562_126_0	4	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					1.00	2.00	3.00											5.00	10.00	15.00				1.00	2.00	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, Select Care Drugs												
H0562	126	0	1	01	01	H0562_126_0	4	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	15.00					1.00	2.00	3.00											5.00	10.00	15.00				1.00	2.00	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, Select Care Drugs										1		
H0562	126	0	1	01	01	H0562_126_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H0562	126	0	1	01	01	H0562_126_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0562	126	0	1	01	01	H0562_126_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	126	0	1	01	01	H0562_126_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	126	0	1	01	01	H0562_126_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0562	127	0	1	01	01	H0562_127_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	127	0	1	01	01	H0562_127_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	127	0	1	01	01	H0562_127_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H0562	127	0	1	01	01	H0562_127_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				100.00	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	127	0	1	01	01	H0562_127_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	127	0	1	01	01	H0562_127_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0571	001	0	1	01	01	H0571_001_0	8	Preferred Generic	4	01	1	2	1	1		111	10	100		1				30	60	90	1	2			90					14	31								3.00	6.00	9.00					3.00	6.00	6.00							6.00																	3.00			3.00			0.10	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	8	Generic	4	01	1	2	2	1		111	10	100		1				30	60	90	1	2			90					14	31								7.00	14.00	21.00					7.00	14.00	14.00							14.00																	7.00			7.00			0.23	0.23				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	8	Preferred Brand	4	11	1	2	3	1		111	10	100		1				30	60	90	1	2			90					14	31								40.00	80.00	120.00					40.00	80.00	80.00							80.00																	40.00			40.00			1.33	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	8	Non-Preferred Drug	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 Drug, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	8	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							14	31											983.94	33						983.94	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	9	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 Drug, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	9	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 Drug, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	9	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 Drug, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	9	Non-Preferred Drug	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 Drug, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	9	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 Drug, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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	007	0	1	01	01	H0609_007_0	3	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	007	0	1	01	01	H0609_007_0	3	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	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	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	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	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												
H0609	012	0	1	01	01	H0609_012_0	3	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	012	0	1	01	01	H0609_012_0	3	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	012	0	1	01	01	H0609_012_0	3	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	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	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	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	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	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	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	025	0	1	01	01	H0609_025_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				407.00	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	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	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	026	0	1	01	01	H0609_026_0	3	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	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	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	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	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												
H0609	027	0	1	01	01	H0609_027_0	3	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	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	027	0	1	01	01	H0609_027_0	3	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	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	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	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	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												
H0609	028	0	1	01	01	H0609_028_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	028	0	1	01	01	H0609_028_0	3	Generic	4	01	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				455.00	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	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	031	0	1	01	01	H0609_031_0	3	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	031	0	1	01	01	H0609_031_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				455.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	032	0	1	01	01	H0609_032_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	032	0	1	01	01	H0609_032_0	3	Generic	4	01	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	032	0	1	01	01	H0609_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	032	0	1	01	01	H0609_032_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				379.00	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	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	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	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	033	0	1	01	01	H0609_033_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	033	0	1	01	01	H0609_033_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				443.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	1	1	01	01	H0609_034_1	3	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	034	1	1	01	01	H0609_034_1	3	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	034	1	1	01	01	H0609_034_1	3	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	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	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	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	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	034	2	1	01	01	H0609_034_2	3	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	034	2	1	01	01	H0609_034_2	3	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	034	2	1	01	01	H0609_034_2	3	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	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	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	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	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	036	1	1	01	01	H0609_036_1	3	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	036	1	1	01	01	H0609_036_1	3	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	036	1	1	01	01	H0609_036_1	3	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	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	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	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	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												
H0609	036	2	1	01	01	H0609_036_2	3	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	036	2	1	01	01	H0609_036_2	3	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	036	2	1	01	01	H0609_036_2	3	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	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	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	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	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												
H0609	037	0	1	01	01	H0609_037_0	3	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	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	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	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	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	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	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												
H0609	038	0	1	01	01	H0609_038_0	3	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											346.00	33						423.00	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	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				548.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	042	0	1	01	01	H0609_042_0	3	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	042	0	1	01	01	H0609_042_0	3	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	042	0	1	01	01	H0609_042_0	3	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	042	0	1	01	01	H0609_042_0	3	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	042	0	1	01	01	H0609_042_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	042	0	1	01	01	H0609_042_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	042	0	1	01	01	H0609_042_0	3	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												
H0609	043	0	1	01	01	H0609_043_0	3	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	043	0	1	01	01	H0609_043_0	3	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	043	0	1	01	01	H0609_043_0	3	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	043	0	1	01	01	H0609_043_0	3	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	043	0	1	01	01	H0609_043_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	043	0	1	01	01	H0609_043_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	043	0	1	01	01	H0609_043_0	3	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												
H0609	044	0	1	01	01	H0609_044_0	3	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	044	0	1	01	01	H0609_044_0	3	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	044	0	1	01	01	H0609_044_0	3	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	044	0	1	01	01	H0609_044_0	3	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	044	0	1	01	01	H0609_044_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	044	0	1	01	01	H0609_044_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	044	0	1	01	01	H0609_044_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				379.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	045	0	1	01	01	H0609_045_0	3	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	045	0	1	01	01	H0609_045_0	3	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	045	0	1	01	01	H0609_045_0	3	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	045	0	1	01	01	H0609_045_0	3	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	045	0	1	01	01	H0609_045_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	045	0	1	01	01	H0609_045_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	045	0	1	01	01	H0609_045_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				407.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	046	0	1	01	01	H0609_046_0	3	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	046	0	1	01	01	H0609_046_0	3	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	046	0	1	01	01	H0609_046_0	3	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												
H0609	046	0	1	01	01	H0609_046_0	3	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
H0609	046	0	1	01	01	H0609_046_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	046	0	1	01	01	H0609_046_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	046	0	1	01	01	H0609_046_0	3	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												
H0609	047	0	1	01	01	H0609_047_0	3	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	047	0	1	01	01	H0609_047_0	3	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	047	0	1	01	01	H0609_047_0	3	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	047	0	1	01	01	H0609_047_0	3	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	047	0	1	01	01	H0609_047_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	047	0	1	01	01	H0609_047_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	047	0	1	01	01	H0609_047_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				360.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	048	0	1	01	01	H0609_048_0	3	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	048	0	1	01	01	H0609_048_0	3	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	048	0	1	01	01	H0609_048_0	3	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	048	0	1	01	01	H0609_048_0	3	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	048	0	1	01	01	H0609_048_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	048	0	1	01	01	H0609_048_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	048	0	1	01	01	H0609_048_0	3	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												
H0628	001	0	1	02	01	H0628_001_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	001	0	1	02	01	H0628_001_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	001	0	1	02	01	H0628_001_0	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	001	0	1	02	01	H0628_001_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	001	0	1	02	01	H0628_001_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	001	0	1	02	01	H0628_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	001	0	1	02	01	H0628_001_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1016.73	33						536.01	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	003	0	1	02	01	H0628_003_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	003	0	1	02	01	H0628_003_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	003	0	1	02	01	H0628_003_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	003	0	1	02	01	H0628_003_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	003	0	1	02	01	H0628_003_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	003	0	1	02	01	H0628_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	003	0	1	02	01	H0628_003_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											997.54	33						469.78	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	005	0	1	02	01	H0628_005_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	005	0	1	02	01	H0628_005_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	005	0	1	02	01	H0628_005_0	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	005	0	1	02	01	H0628_005_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	005	0	1	02	01	H0628_005_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	005	0	1	02	01	H0628_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	005	0	1	02	01	H0628_005_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											886.87	33						405.99	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	006	0	1	02	01	H0628_006_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	006	0	1	02	01	H0628_006_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	006	0	1	02	01	H0628_006_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	006	0	1	02	01	H0628_006_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	006	0	1	02	01	H0628_006_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	006	0	1	02	01	H0628_006_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	006	0	1	02	01	H0628_006_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1131.07	33						484.06	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	007	0	1	02	01	H0628_007_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	007	0	1	02	01	H0628_007_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	007	0	1	02	01	H0628_007_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	007	0	1	02	01	H0628_007_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	007	0	1	02	01	H0628_007_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	007	0	1	02	01	H0628_007_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	007	0	1	02	01	H0628_007_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1131.07	33						484.06	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	008	0	1	02	01	H0628_008_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	008	0	1	02	01	H0628_008_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	008	0	1	02	01	H0628_008_0	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	008	0	1	02	01	H0628_008_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	008	0	1	02	01	H0628_008_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	008	0	1	02	01	H0628_008_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	008	0	1	02	01	H0628_008_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1131.07	33						484.06	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	009	0	1	02	01	H0628_009_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	009	0	1	02	01	H0628_009_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	009	0	1	02	01	H0628_009_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	009	0	1	02	01	H0628_009_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	009	0	1	02	01	H0628_009_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	009	0	1	02	01	H0628_009_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	009	0	1	02	01	H0628_009_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1131.07	33						484.06	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	010	0	1	02	01	H0628_010_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	010	0	1	02	01	H0628_010_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	010	0	1	02	01	H0628_010_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	010	0	1	02	01	H0628_010_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	010	0	1	02	01	H0628_010_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	010	0	1	02	01	H0628_010_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	010	0	1	02	01	H0628_010_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1131.07	33						484.06	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	011	0	1	01	01	H0628_011_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	011	0	1	01	01	H0628_011_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	011	0	1	01	01	H0628_011_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	011	0	1	01	01	H0628_011_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	011	0	1	01	01	H0628_011_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	011	0	1	01	01	H0628_011_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	011	0	1	01	01	H0628_011_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1131.07	33						484.06	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	012	0	1	01	01	H0628_012_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H0628	012	0	1	01	01	H0628_012_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H0628	012	0	1	01	01	H0628_012_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	012	0	1	01	01	H0628_012_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											41.50	25	25	25				39.84	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	012	0	1	01	01	H0628_012_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											589.17	25						382.64	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	013	0	1	01	01	H0628_013_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H0628	013	0	1	01	01	H0628_013_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H0628	013	0	1	01	01	H0628_013_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	013	0	1	01	01	H0628_013_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											43.78	25	25	25				39.52	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	013	0	1	01	01	H0628_013_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											571.15	25						356.54	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	017	0	1	02	01	H0628_017_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	017	0	1	02	01	H0628_017_0	4	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	017	0	1	02	01	H0628_017_0	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	017	0	1	02	01	H0628_017_0	4	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0628	017	0	1	02	01	H0628_017_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	017	0	1	02	01	H0628_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	017	0	1	02	01	H0628_017_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1083.93	33						476.59	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0630	013	0	1	01	01	H0630_013_0	8	Preferred Generic	4	11	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	013	0	1	01	01	H0630_013_0	8	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.00		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	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				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	8	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	240.00				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												
H0630	013	0	1	01	01	H0630_013_0	8	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	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	8	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	9	Preferred Generic	4	11	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	015	0	1	01	01	H0630_015_0	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.00		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	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	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	240.00				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												
H0630	015	0	1	01	01	H0630_015_0	9	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	9	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	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	Preferred Generic	4	11	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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.00		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	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	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	240.00				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												
H0630	016	0	1	01	01	H0630_016_0	9	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	9	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	8	Preferred Generic	4	11	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	017	0	1	01	01	H0630_017_0	8	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.16		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	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	8	Non-Preferred Brand	4	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	240.00				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												
H0630	017	0	1	01	01	H0630_017_0	8	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	8	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	8	Preferred Generic	4	11	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	020	0	1	01	01	H0630_020_0	8	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.00		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	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				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	8	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	240.00				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												
H0630	020	0	1	01	01	H0630_020_0	8	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	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	8	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	9	Preferred Generic	4	11	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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.00		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	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	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	240.00				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												
H0630	021	0	1	01	01	H0630_021_0	9	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	9	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	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	Preferred Generic	4	11	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	023	0	1	01	01	H0630_023_0	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.16		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	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	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	240.00				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												
H0630	023	0	1	01	01	H0630_023_0	9	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	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	023	0	1	01	01	H0630_023_0	9	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0672	001	0	1	01	01	H0672_001_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				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												
H0672	001	0	1	01	01	H0672_001_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					4.00	8.00	10.00											15.00	30.00	37.50				0.00	0.00	0.00				15.00				15.00			0.50	0.13		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	001	0	1	01	01	H0672_001_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	001	0	1	01	01	H0672_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											878.87	33						884.74	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	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	17.50					0.00	0.00	0.00											7.00	14.00	17.50				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												
H0672	002	0	1	01	01	H0672_002_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					4.00	8.00	10.00											15.00	30.00	37.50				0.00	0.00	0.00				15.00				15.00			0.50	0.13		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	002	0	1	01	01	H0672_002_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	002	0	1	01	01	H0672_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											607.11	33						823.04	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	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	17.50					0.00	0.00	0.00											7.00	14.00	17.50				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												
H0672	003	0	1	01	01	H0672_003_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					4.00	8.00	10.00											15.00	30.00	37.50				0.00	0.00	0.00				15.00				15.00			0.50	0.13		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	003	0	1	01	01	H0672_003_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	003	0	1	01	01	H0672_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											899.24	33						915.33	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	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	17.50					0.00	0.00	0.00											7.00	14.00	17.50				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												
H0672	004	0	1	01	01	H0672_004_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					4.00	8.00	10.00											15.00	30.00	37.50				0.00	0.00	0.00				15.00				15.00			0.50	0.13		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	004	0	1	01	01	H0672_004_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	004	0	1	01	01	H0672_004_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											899.24	33						915.33	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	Preferred Generic	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	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	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	005	0	1	01	01	H0672_005_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	005	0	1	01	01	H0672_005_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											899.19	33						916.25	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	006	0	1	01	01	H0672_006_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	006	0	1	01	01	H0672_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	006	0	1	01	01	H0672_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											914.60	33						760.36	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	007	0	1	01	01	H0672_007_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	007	0	1	01	01	H0672_007_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					4.00	8.00	10.00											15.00	30.00	37.50				0.00	0.00	0.00				15.00				15.00			0.50	0.13		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	007	0	1	01	01	H0672_007_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	007	0	1	01	01	H0672_007_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	007	0	1	01	01	H0672_007_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											899.24	33						915.33	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	008	0	1	01	01	H0672_008_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				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												
H0672	008	0	1	01	01	H0672_008_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					4.00	8.00	10.00											15.00	30.00	37.50				0.00	0.00	0.00				15.00				15.00			0.50	0.13		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	008	0	1	01	01	H0672_008_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	008	0	1	01	01	H0672_008_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	008	0	1	01	01	H0672_008_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											899.24	33						915.33	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	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												
H0710	008	0	1	04	01	H0710_008_0	3	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												
H0710	008	0	1	04	01	H0710_008_0	3	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
H0710	008	0	1	04	01	H0710_008_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				265.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3	Generic	4	01	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				298.00	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	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	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				298.00	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	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												
H0710	030	0	1	04	01	H0710_030_0	3	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												
H0710	030	0	1	04	01	H0710_030_0	3	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
H0710	030	0	1	04	01	H0710_030_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	030	0	1	04	01	H0710_030_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	030	0	1	04	01	H0710_030_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				350.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	037	0	1	04	01	H0710_037_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	037	0	1	04	01	H0710_037_0	4	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												
H0710	037	0	1	04	01	H0710_037_0	4	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
H0710	037	0	1	04	01	H0710_037_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	037	0	1	04	01	H0710_037_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	037	0	1	04	01	H0710_037_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				170.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	047	0	1	04	01	H0710_047_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	047	0	1	04	01	H0710_047_0	3	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												
H0710	047	0	1	04	01	H0710_047_0	3	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
H0710	047	0	1	04	01	H0710_047_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	047	0	1	04	01	H0710_047_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	047	0	1	04	01	H0710_047_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				298.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	050	0	1	04	01	H0710_050_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				297.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	054	0	1	04	01	H0710_054_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	054	0	1	04	01	H0710_054_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	054	0	1	04	01	H0710_054_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	054	0	1	04	01	H0710_054_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	054	0	1	04	01	H0710_054_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	054	0	1	04	01	H0710_054_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				298.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	055	0	1	04	01	H0710_055_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	055	0	1	04	01	H0710_055_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	055	0	1	04	01	H0710_055_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	055	0	1	04	01	H0710_055_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	055	0	1	04	01	H0710_055_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	055	0	1	04	01	H0710_055_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				298.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	056	0	1	04	01	H0710_056_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	056	0	1	04	01	H0710_056_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	056	0	1	04	01	H0710_056_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	056	0	1	04	01	H0710_056_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	056	0	1	04	01	H0710_056_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	056	0	1	04	01	H0710_056_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				298.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	057	0	1	04	01	H0710_057_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	057	0	1	04	01	H0710_057_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	057	0	1	04	01	H0710_057_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	057	0	1	04	01	H0710_057_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	057	0	1	04	01	H0710_057_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	057	0	1	04	01	H0710_057_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				298.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	058	0	1	04	01	H0710_058_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	058	0	1	04	01	H0710_058_0	3	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												
H0710	058	0	1	04	01	H0710_058_0	3	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
H0710	058	0	1	04	01	H0710_058_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	058	0	1	04	01	H0710_058_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	058	0	1	04	01	H0710_058_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				298.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	059	0	1	04	01	H0710_059_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	059	0	1	04	01	H0710_059_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	059	0	1	04	01	H0710_059_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	059	0	1	04	01	H0710_059_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	059	0	1	04	01	H0710_059_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	059	0	1	04	01	H0710_059_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				298.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	005	0	1	01	01	H0712_005_0	6	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																									14.00	28.00	42.00				14.00	28.00	0.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	005	0	1	01	01	H0712_005_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	005	0	1	01	01	H0712_005_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.68	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	005	0	1	01	01	H0712_005_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	005	0	1	01	01	H0712_005_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	019	0	1	01	01	H0712_019_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	2.00	3.00					0.00	0.00	0.00											1.00	2.00	3.00				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												
H0712	019	0	1	01	01	H0712_019_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	019	0	1	01	01	H0712_019_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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												
H0712	019	0	1	01	01	H0712_019_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.77	45	45	45				95.34	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	019	0	1	01	01	H0712_019_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	019	0	1	01	01	H0712_019_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	019	0	1	01	01	H0712_019_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0712	020	0	1	01	01	H0712_020_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	020	0	1	01	01	H0712_020_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	020	0	1	01	01	H0712_020_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	020	0	1	01	01	H0712_020_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.69	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	020	0	1	01	01	H0712_020_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	020	0	1	01	01	H0712_020_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	023	0	1	01	01	H0712_023_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	023	0	1	01	01	H0712_023_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H0712	023	0	1	01	01	H0712_023_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H0712	023	0	1	01	01	H0712_023_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.83	48	48	48				95.67	46	46	46										48	48	48				46	46	46			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	023	0	1	01	01	H0712_023_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	023	0	1	01	01	H0712_023_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	025	0	1	01	01	H0712_025_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	025	0	1	01	01	H0712_025_0	6	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	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	025	0	1	01	01	H0712_025_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	35.00	70.00	105.00																									35.00	70.00	105.00				35.00	70.00	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												
H0712	025	0	1	01	01	H0712_025_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.49	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	025	0	1	01	01	H0712_025_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	025	0	1	01	01	H0712_025_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	029	0	1	01	01	H0712_029_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	029	0	1	01	01	H0712_029_0	5	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	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	029	0	1	01	01	H0712_029_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	35.00	70.00	105.00																									35.00	70.00	105.00				35.00	70.00	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												
H0712	029	0	1	01	01	H0712_029_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				96.58	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	029	0	1	01	01	H0712_029_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	029	0	1	01	01	H0712_029_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	42.00				9.00	18.00	0.00				14.00				14.00			0.47	0.3		0.47	0.3	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H0724	001	0	1	01	01	H0724_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0724	006	0	1	01	01	H0724_006_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	006	0	1	01	01	H0724_006_0	4	Preferred Generic	4	11	3	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0724	006	0	1	01	01	H0724_006_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	006	0	1	01	01	H0724_006_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H0724	006	0	1	01	01	H0724_006_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.14	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	006	0	1	01	01	H0724_006_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	006	0	1	01	01	H0724_006_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	006	0	1	01	01	H0724_006_0	4	Select Care Drugs	4	11	1	2	6	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0724	007	0	1	01	01	H0724_007_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	007	0	1	01	01	H0724_007_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	42.00				9.00	18.00	0.00				14.00				14.00			0.47	0.3		0.47	0.3	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	Preferred Brand	4	11	1	2	3	1		111	01		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												
H0724	007	0	1	01	01	H0724_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0724	007	0	1	01	01	H0724_007_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	007	0	1	01	01	H0724_007_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	007	0	1	01	01	H0724_007_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0755	030	0	1	01	01	H0755_030_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0755	030	0	1	01	01	H0755_030_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				413.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				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												
H0755	031	0	1	01	01	H0755_031_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0755	031	0	1	01	01	H0755_031_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				280.00	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	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	Preferred Generic	4	01	1	2	1	3	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										1		
H0755	033	0	1	01	01	H0755_033_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				238.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0755	038	0	1	01	01	H0755_038_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	038	0	1	01	01	H0755_038_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	3	Specialty Tier	4	11	1	1	5	1	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	043	0	1	01	01	H0755_043_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	043	0	1	01	01	H0755_043_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0755	043	0	1	01	01	H0755_043_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	043	0	1	01	01	H0755_043_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	043	0	1	01	01	H0755_043_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	043	0	1	01	01	H0755_043_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	043	0	1	01	01	H0755_043_0	3	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												
H0755	044	0	1	01	01	H0755_044_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	044	0	1	01	01	H0755_044_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0755	044	0	1	01	01	H0755_044_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	044	0	1	01	01	H0755_044_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	044	0	1	01	01	H0755_044_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	044	0	1	01	01	H0755_044_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	044	0	1	01	01	H0755_044_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				246.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	045	0	1	01	01	H0755_045_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	045	0	1	01	01	H0755_045_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0755	045	0	1	01	01	H0755_045_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	045	0	1	01	01	H0755_045_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	045	0	1	01	01	H0755_045_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	045	0	1	01	01	H0755_045_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	045	0	1	01	01	H0755_045_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				284.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	002	0	1	01	01	H0783_002_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					2.00		6.00											15.00		45.00				2.00		0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	002	0	1	01	01	H0783_002_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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												
H0783	002	0	1	01	01	H0783_002_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	002	0	1	01	01	H0783_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	002	0	1	01	01	H0783_002_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												
H0798	001	0	1	01	01	H0798_001_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0798	001	0	1	01	01	H0798_001_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					14.00	28.00	42.00											20.00	40.00	60.00				14.00	28.00	0.00				20.00				14.00			0.67	0.47		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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00			1.57	1.57		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	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											113.17	46	46	46				91.16	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0798	001	0	1	01	01	H0798_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0826	001	0	1	01	01	H0826_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0826	001	0	1	01	01	H0826_001_0	4	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0826	001	0	1	01	01	H0826_001_0	4	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0826	001	0	1	01	01	H0826_001_0	4	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0826	001	0	1	01	01	H0826_001_0	4	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		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0826	001	0	1	01	01	H0826_001_0	4	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				689.51	31																																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0838	020	0	1	01	01	H0838_020_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	020	0	1	01	01	H0838_020_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	020	0	1	01	01	H0838_020_0	6	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				7.63	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	6	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				74.41	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	6	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				56.18	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				566.71	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	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	020	0	1	01	01	H0838_020_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	024	0	1	01	01	H0838_024_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	024	0	1	01	01	H0838_024_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	024	0	1	01	01	H0838_024_0	5	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				8.43	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	5	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				102.08	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	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				60.45	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				467.60	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	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	024	0	1	01	01	H0838_024_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	025	0	1	01	01	H0838_025_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	025	0	1	01	01	H0838_025_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	025	0	1	01	01	H0838_025_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100.00		300.00																					200																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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				727.20	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	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	028	0	1	01	01	H0838_028_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	028	0	1	01	01	H0838_028_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	5		15																					10																5				5		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	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	45		135																					90																45				45		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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	90		270																					180																90				90		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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				501.19	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	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	029	0	1	01	01	H0838_029_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	029	0	1	01	01	H0838_029_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	029	0	1	01	01	H0838_029_0	5	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				7.73	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	5	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				92.72	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	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				50.21	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				580.67	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	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	029	0	1	01	01	H0838_029_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	032	0	1	01	01	H0838_032_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0.00		0.00																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	032	0	1	01	01	H0838_032_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	45.00		135.00																					90																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	90.00		270.00																					180																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				565.15	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0.00		0.00																					0																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	033	0	1	01	01	H0838_033_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	033	0	1	01	01	H0838_033_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	033	0	1	01	01	H0838_033_0	5	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				10.43	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	5	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				108.90	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	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				63.79	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				547.25	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	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	033	0	1	01	01	H0838_033_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	037	0	1	01	01	H0838_037_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	037	0	1	01	01	H0838_037_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				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	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				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 Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				657.81	32																				32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	039	1	1	01	01	H0838_039_1	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	039	1	1	01	01	H0838_039_1	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				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	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				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												
H0838	039	1	1	01	01	H0838_039_1	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				523.01	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	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	039	2	1	01	01	H0838_039_2	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	039	2	1	01	01	H0838_039_2	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				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	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				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												
H0838	039	2	1	01	01	H0838_039_2	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				523.01	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	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	040	1	1	01	01	H0838_040_1	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	040	1	1	01	01	H0838_040_1	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	040	1	1	01	01	H0838_040_1	5	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				10.63	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	5	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				108.69	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	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				71.26	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				659.88	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	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	040	1	1	01	01	H0838_040_1	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	040	2	1	01	01	H0838_040_2	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	040	2	1	01	01	H0838_040_2	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	040	2	1	01	01	H0838_040_2	5	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				10.63	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	5	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				108.69	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	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				71.26	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				659.88	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	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	040	2	1	01	01	H0838_040_2	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	042	0	1	01	01	H0838_042_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	042	0	1	01	01	H0838_042_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	50.00		150.00																					100.00																50.00				50.00		1.67						1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				257.04	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	043	0	1	01	01	H0838_043_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	043	0	1	01	01	H0838_043_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	12		36																					24																12				12		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	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		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	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				339.03	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	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	044	0	1	01	01	H0838_044_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	044	0	1	01	01	H0838_044_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	044	0	1	01	01	H0838_044_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	044	0	1	01	01	H0838_044_0	6	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				48.70	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	6	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				23.40	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				317.26	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	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	044	0	1	01	01	H0838_044_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	045	0	1	01	01	H0838_045_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	045	0	1	01	01	H0838_045_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	045	0	1	01	01	H0838_045_0	6	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				5.16	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	6	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				48.70	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	6	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				23.40	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				317.27	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	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	045	0	1	01	01	H0838_045_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	046	0	1	01	01	H0838_046_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	046	0	1	01	01	H0838_046_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	046	0	1	01	01	H0838_046_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	12		36																					24																12				12		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	046	0	1	01	01	H0838_046_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	046	0	1	01	01	H0838_046_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	046	0	1	01	01	H0838_046_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				530.49	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	046	0	1	01	01	H0838_046_0	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	046	0	1	01	01	H0838_046_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	047	0	1	01	01	H0838_047_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	047	0	1	01	01	H0838_047_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	047	0	1	01	01	H0838_047_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	12		36																					24																12				12		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	047	0	1	01	01	H0838_047_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	047	0	1	01	01	H0838_047_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	047	0	1	01	01	H0838_047_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				414.32	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	047	0	1	01	01	H0838_047_0	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	047	0	1	01	01	H0838_047_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0838	049	0	1	01	01	H0838_049_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	049	0	1	01	01	H0838_049_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H0838	049	0	1	01	01	H0838_049_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	12.00		36.00																					12.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	049	0	1	01	01	H0838_049_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				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	049	0	1	01	01	H0838_049_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				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 Care Drugs												
H0838	049	0	1	01	01	H0838_049_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				647.54	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	049	0	1	01	01	H0838_049_0	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H0838	049	0	1	01	01	H0838_049_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H0876	001	0	1	01	01	H0876_001_0	9	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												
H0876	001	0	1	01	01	H0876_001_0	9	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												
H0876	001	0	1	01	01	H0876_001_0	9	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												
H0876	001	0	1	01	01	H0876_001_0	9	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												
H0876	001	0	1	01	01	H0876_001_0	9	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												
H0885	001	0	1	04	01	H0885_001_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	001	0	1	04	01	H0885_001_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			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, Select Care Drugs												
H0885	001	0	1	04	01	H0885_001_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	001	0	1	04	01	H0885_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	001	0	1	04	01	H0885_001_0	6	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, Select Care Drugs												
H0885	001	0	1	04	01	H0885_001_0	6	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	002	0	1	04	01	H0885_002_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	002	0	1	04	01	H0885_002_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			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, Select Care Drugs												
H0885	002	0	1	04	01	H0885_002_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	002	0	1	04	01	H0885_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	002	0	1	04	01	H0885_002_0	6	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, Select Care Drugs												
H0885	002	0	1	04	01	H0885_002_0	6	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					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												
H0907	001	0	1	01	01	H0907_001_0	7	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												
H0907	001	0	1	01	01	H0907_001_0	7	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	120.00					40.00	120.00	120.00																40.00				40.00			1.33	1.33	1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0907	001	0	1	01	01	H0907_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0907	001	0	1	01	01	H0907_001_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				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												
H0908	001	0	1	01	01	H0908_001_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	001	0	1	01	01	H0908_001_0	4	Preferred Generic	4	11	3	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0908	001	0	1	01	01	H0908_001_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	9.00	18.00	27.00																									9.00	18.00	27.00				9.00	18.00	0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	001	0	1	01	01	H0908_001_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	120.00																									40.00	80.00	120.00				40.00	80.00	80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	001	0	1	01	01	H0908_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				95.20	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	001	0	1	01	01	H0908_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	001	0	1	01	01	H0908_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	001	0	1	01	01	H0908_001_0	4	Select Care Drugs	4	11	1	2	6	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0908	003	0	1	01	01	H0908_003_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	003	0	1	01	01	H0908_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	42.00				9.00	18.00	0.00				14.00				14.00			0.47	0.3		0.47	0.3	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	003	0	1	01	01	H0908_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H0908	003	0	1	01	01	H0908_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H0908	003	0	1	01	01	H0908_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	003	0	1	01	01	H0908_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	003	0	1	01	01	H0908_003_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0908	004	0	1	01	01	H0908_004_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	004	0	1	01	01	H0908_004_0	4	Preferred Generic	4	11	3	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0908	004	0	1	01	01	H0908_004_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	004	0	1	01	01	H0908_004_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H0908	004	0	1	01	01	H0908_004_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.14	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	004	0	1	01	01	H0908_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	004	0	1	01	01	H0908_004_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	004	0	1	01	01	H0908_004_0	4	Select Care Drugs	4	11	1	2	6	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0908	005	0	1	01	01	H0908_005_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	005	0	1	01	01	H0908_005_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	005	0	1	01	01	H0908_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H0908	005	0	1	01	01	H0908_005_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.92	50	50	50				94.01	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	005	0	1	01	01	H0908_005_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	005	0	1	01	01	H0908_005_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	002	0	1	02	01	H0913_002_0	5	Preferred Generic	4	11	3	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	4.00	6.00				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, Select Care Drugs												
H0913	002	0	1	02	01	H0913_002_0	5	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					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												
H0913	002	0	1	02	01	H0913_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H0913	002	0	1	02	01	H0913_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.60	50	50	50				94.65	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	002	0	1	02	01	H0913_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	002	0	1	02	01	H0913_002_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	013	0	1	01	01	H0913_013_0	7	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	013	0	1	01	01	H0913_013_0	7	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	18.00	36.00	54.00																									18.00	36.00	54.00				18.00	36.00	0.00				18.00				18.00		0.6				0.6	0.6	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	013	0	1	01	01	H0913_013_0	7	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	013	0	1	01	01	H0913_013_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.40	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	013	0	1	01	01	H0913_013_0	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	013	0	1	01	01	H0913_013_0	7	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	015	0	1	01	01	H0913_015_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	015	0	1	01	01	H0913_015_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	015	0	1	01	01	H0913_015_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H0913	015	0	1	01	01	H0913_015_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				96.45	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	015	0	1	01	01	H0913_015_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	015	0	1	01	01	H0913_015_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	017	0	1	01	01	H0913_017_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	017	0	1	01	01	H0913_017_0	5	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					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												
H0913	017	0	1	01	01	H0913_017_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H0913	017	0	1	01	01	H0913_017_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.03	45	45	45				93.67	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	017	0	1	01	01	H0913_017_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	017	0	1	01	01	H0913_017_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0927	001	0	1	48	05	H0927_001_0	2	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	2	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	2	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	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	001	0	1	04	01	H0969_001_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H0969	001	0	1	04	01	H0969_001_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H0969	001	0	1	04	01	H0969_001_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.44	45	45	45				95.02	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	001	0	1	04	01	H0969_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	001	0	1	04	01	H0969_001_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	002	0	1	04	01	H0969_002_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	002	0	1	04	01	H0969_002_0	6	Preferred Generic	4	11	3	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0969	002	0	1	04	01	H0969_002_0	6	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	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	002	0	1	04	01	H0969_002_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H0969	002	0	1	04	01	H0969_002_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.70	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	002	0	1	04	01	H0969_002_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	002	0	1	04	01	H0969_002_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	002	0	1	04	01	H0969_002_0	6	Select Care Drugs	4	11	1	2	6	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0969	003	0	1	04	01	H0969_003_0	7	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	003	0	1	04	01	H0969_003_0	7	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	003	0	1	04	01	H0969_003_0	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H0969	003	0	1	04	01	H0969_003_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.46	50	50	50				91.64	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	003	0	1	04	01	H0969_003_0	7	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												
H0969	003	0	1	04	01	H0969_003_0	7	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	003	0	1	04	01	H0969_003_0	7	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0969	005	0	1	04	01	H0969_005_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	005	0	1	04	01	H0969_005_0	6	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	9.00	18.00	27.00																									9.00	18.00	27.00				9.00	18.00	0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	005	0	1	04	01	H0969_005_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	120.00																									40.00	80.00	120.00				40.00	80.00	80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	005	0	1	04	01	H0969_005_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.42	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	005	0	1	04	01	H0969_005_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	005	0	1	04	01	H0969_005_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0978	001	0	1	01	01	H0978_001_0	5	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												
H0978	001	0	1	01	01	H0978_001_0	5	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
H0978	001	0	1	01	01	H0978_001_0	5	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					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												
H0978	001	0	1	01	01	H0978_001_0	5	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					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		
H0978	001	0	1	01	01	H0978_001_0	5	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												
H0978	001	0	1	01	01	H0978_001_0	5	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												
H0978	001	0	1	01	01	H0978_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	002	0	1	01	01	H0978_002_0	5	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												
H0978	002	0	1	01	01	H0978_002_0	5	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		
H0978	002	0	1	01	01	H0978_002_0	5	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					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												
H0978	002	0	1	01	01	H0978_002_0	5	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					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		
H0978	002	0	1	01	01	H0978_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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												
H0978	002	0	1	01	01	H0978_002_0	5	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												
H0978	002	0	1	01	01	H0978_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	003	0	1	01	01	H0978_003_0	5	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												
H0978	003	0	1	01	01	H0978_003_0	5	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		
H0978	003	0	1	01	01	H0978_003_0	5	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					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												
H0978	003	0	1	01	01	H0978_003_0	5	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					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		
H0978	003	0	1	01	01	H0978_003_0	5	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												
H0978	003	0	1	01	01	H0978_003_0	5	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												
H0978	003	0	1	01	01	H0978_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	004	0	1	01	01	H0978_004_0	5	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					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												
H0978	004	0	1	01	01	H0978_004_0	5	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					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		3
H0978	004	0	1	01	01	H0978_004_0	5	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					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												
H0978	004	0	1	01	01	H0978_004_0	5	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												
H0978	004	0	1	01	01	H0978_004_0	5	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												
H0978	004	0	1	01	01	H0978_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0982	001	0	1	01	01	H0982_001_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	001	0	1	01	01	H0982_001_0	8	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	001	0	1	01	01	H0982_001_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	001	0	1	01	01	H0982_001_0	8	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	001	0	1	01	01	H0982_001_0	8	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	8	Non-Preferred Brand	4	10	1	2	4	1	110		01			1	30		90				2	2							30		31	10.00		25.00																																					10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	001	0	1	01	01	H0982_001_0	8	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1573.09	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	001	0	1	01	01	H0982_001_0	8	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	8	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	002	0	1	01	01	H0982_002_0	8	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	002	0	1	01	01	H0982_002_0	8	Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				2	2							30		31					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	8	Non-Preferred Brand	4	10	1	1	4	1	110		01			1	30		90				2	2							30		31					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	8	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	002	0	1	01	01	H0982_002_0	8	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	005	0	1	01	01	H0982_005_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	005	0	1	01	01	H0982_005_0	8	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	005	0	1	01	01	H0982_005_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	005	0	1	01	01	H0982_005_0	8	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	005	0	1	01	01	H0982_005_0	8	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	8	Non-Preferred Brand	4	10	1	2	4	1	110		01			1	30		90				2	2							30		31	70.00		200.00																																					70.00				70.00		2.33						2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	005	0	1	01	01	H0982_005_0	8	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1643.40	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	005	0	1	01	01	H0982_005_0	8	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	8	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	006	0	1	01	01	H0982_006_0	8	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	006	0	1	01	01	H0982_006_0	8	Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				2	2							30		31					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	8	Non-Preferred Brand	4	10	1	1	4	1	110		01			1	30		90				2	2							30		31					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	8	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	006	0	1	01	01	H0982_006_0	8	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	007	0	1	01	01	H0982_007_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	8	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	007	0	1	01	01	H0982_007_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	8	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	007	0	1	01	01	H0982_007_0	8	Preferred Brand	4	10	1	2	3	1	110		01			1	30		90				2	2							30		31	15.00		40.00																																					15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01			1	30		90				2	2							30		31	70.00		200.00																																					70.00				70.00		2.33						2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	8	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1643.67	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	8	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	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	008	0	1	01	01	H0982_008_0	8	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	008	0	1	01	01	H0982_008_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	008	0	1	01	01	H0982_008_0	8	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	008	0	1	01	01	H0982_008_0	8	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	8	Non-Preferred Brand	4	10	1	2	4	1	110		01			1	30		90				2	2							30		31	75.00		225.00																																					75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	008	0	1	01	01	H0982_008_0	8	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1644.50	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	008	0	1	01	01	H0982_008_0	8	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	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	8	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	009	0	1	01	01	H0982_009_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	8	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	009	0	1	01	01	H0982_009_0	8	Preferred Brand	4	10	1	2	3	1	110		01			1	30		90				2	2							30		31	15.00		40.00																																					15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01			1	30		90				2	2							30		31	75.00		225.00																																					75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	8	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1641.13	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	8	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	8	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	010	0	1	01	01	H0982_010_0	8	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	010	0	1	01	01	H0982_010_0	8	Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				2	2							30		31					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	8	Non-Preferred Brand	4	10	1	1	4	1	110		01			1	30		90				2	2							30		31					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	8	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	010	0	1	01	01	H0982_010_0	8	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	011	0	1	01	01	H0982_011_0	9	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	011	0	1	01	01	H0982_011_0	9	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	9	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	9	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	9	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	9	Non-Preferred Brand	4	10	1	1	4	1	110		01			1	30		90				2	2							30		31				138.20	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	9	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				990.10	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	011	0	1	01	01	H0982_011_0	9	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	8	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	012	0	1	01	01	H0982_012_0	8	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	012	0	1	01	01	H0982_012_0	8	Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				2	2							30		31					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	8	Non-Preferred Brand	4	10	1	1	4	1	110		01			1	30		90				2	2							30		31					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	8	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	012	0	1	01	01	H0982_012_0	8	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	013	0	1	01	01	H0982_013_0	8	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	013	0	1	01	01	H0982_013_0	8	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	013	0	1	01	01	H0982_013_0	8	Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				2	2							30		31					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	8	Non-Preferred Brand	4	10	1	1	4	1	110		01			1	30		90				2	2							30		31					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	8	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	013	0	1	01	01	H0982_013_0	8	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												
H1016	001	0	1	01	01	H1016_001_0	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	023	0	1	01	01	H1016_023_0	6	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	6	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					60.00	120.00	150.00											85.00	170.00	255.00				60.00	120.00	150.00				85.00				60.00			2.83	2.00		2.83	2.00	1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	6	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	6	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	6	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	6	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	6	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	6	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					10.00	20.00	25.00											30.00	60.00	90.00				10.00	20.00	25.00				30.00				10.00			1.00	0.33		1.00	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	7	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	7	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	7	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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	6	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	006	0	1	01	01	H1019_006_0	6	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	6	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	006	0	1	01	01	H1019_006_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	02	01	H1019_057_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	02	01	H1019_057_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	057	0	1	02	01	H1019_057_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	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	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	Non-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	Specialty Tier	4	11	1	1	5	1		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	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	3	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	065	0	1	01	01	H1019_065_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					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	3	Generic	4	11	1	2	2	3		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										1		
H1019	065	0	1	01	01	H1019_065_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	069	0	1	01	01	H1019_069_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	069	0	1	01	01	H1019_069_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	6	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	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	3	Non-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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	089	0	1	01	01	H1019_089_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	089	0	1	01	01	H1019_089_0	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	089	0	1	01	01	H1019_089_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	089	0	1	01	01	H1019_089_0	4	Generic	4	11	1	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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	24		24				23.00	21		21										24		24				21		21			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	089	0	1	01	01	H1019_089_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	24		24				27.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_0	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	3	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	3	Non-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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	098	0	1	01	01	H1019_098_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	098	0	1	01	01	H1019_098_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		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	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	099	0	1	01	01	H1019_099_0	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	099	0	1	01	01	H1019_099_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	099	0	1	01	01	H1019_099_0	3	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	3	Non-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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	102	0	1	01	01	H1019_102_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	102	0	1	01	01	H1019_102_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					15.00		45.00											47.00		141.00				15.00		30.00				47.00				47.00			1.57	0.50		1.57	0.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	102	0	1	01	01	H1019_102_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	1	1	01	01	H1019_103_1	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	1	1	01	01	H1019_103_1	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	103	1	1	01	01	H1019_103_1	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	103	1	1	01	01	H1019_103_1	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	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					45.00		135.00											100.00		300.00				45.00		125.00				100.00				100.00			3.33	1.50		3.33	1.50	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	1	1	01	01	H1019_103_1	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	2	1	01	01	H1019_103_2	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	2	1	01	01	H1019_103_2	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	103	2	1	01	01	H1019_103_2	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	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	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	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					45.00		135.00											100.00		300.00				45.00		125.00				100.00				100.00			3.33	1.50		3.33	1.50	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	2	1	01	01	H1019_103_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	1	1	01	01	H1019_104_1	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	3	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	104	1	1	01	01	H1019_104_1	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	3	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	104	1	1	01	01	H1019_104_1	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	3	Non-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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	2	1	01	01	H1019_104_2	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	3	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	104	2	1	01	01	H1019_104_2	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	3	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	104	2	1	01	01	H1019_104_2	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	3	Non-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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	105	0	1	01	01	H1019_105_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	105	0	1	01	01	H1019_105_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	105	0	1	01	01	H1019_105_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	105	0	1	01	01	H1019_105_0	5	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	105	0	1	01	01	H1019_105_0	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	106	0	1	01	01	H1019_106_0	5	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	106	0	1	01	01	H1019_106_0	5	Generic	4	11	1	2	2	3		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										1		
H1019	106	0	1	01	01	H1019_106_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	107	0	1	01	01	H1019_107_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	107	0	1	01	01	H1019_107_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		95.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	108	0	1	01	01	H1019_108_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	109	0	1	01	01	H1019_109_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	110	0	1	02	01	H1019_110_0	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	110	0	1	02	01	H1019_110_0	3	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	110	0	1	02	01	H1019_110_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	3	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	110	0	1	02	01	H1019_110_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	3	Non-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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	111	0	1	01	01	H1019_111_0	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	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	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	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	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	Non-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	Specialty Tier	4	11	1	1	5	1		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	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		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	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	112	0	1	01	01	H1019_112_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	112	0	1	01	01	H1019_112_0	3	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	112	0	1	01	01	H1019_112_0	3	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	Non-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	Specialty Tier	4	11	1	1	5	1		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	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	113	0	1	01	01	H1019_113_0	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	113	0	1	01	01	H1019_113_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	113	0	1	01	01	H1019_113_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	114	0	1	01	01	H1019_114_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	114	0	1	01	01	H1019_114_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	114	0	1	01	01	H1019_114_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	114	0	1	01	01	H1019_114_0	5	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	114	0	1	01	01	H1019_114_0	5	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	114	0	1	01	01	H1019_114_0	5	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	114	0	1	01	01	H1019_114_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	115	0	1	01	01	H1019_115_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	115	0	1	01	01	H1019_115_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	115	0	1	01	01	H1019_115_0	5	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	115	0	1	01	01	H1019_115_0	5	Generic	4	11	1	2	2	3		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										1		
H1019	115	0	1	01	01	H1019_115_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	115	0	1	01	01	H1019_115_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	115	0	1	01	01	H1019_115_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	116	0	1	01	01	H1019_116_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	116	0	1	01	01	H1019_116_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	116	0	1	01	01	H1019_116_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	116	0	1	01	01	H1019_116_0	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	116	0	1	01	01	H1019_116_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		95.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	116	0	1	01	01	H1019_116_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	116	0	1	01	01	H1019_116_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	117	0	1	01	01	H1019_117_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	117	0	1	01	01	H1019_117_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	117	0	1	01	01	H1019_117_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	117	0	1	01	01	H1019_117_0	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	117	0	1	01	01	H1019_117_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	117	0	1	01	01	H1019_117_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	117	0	1	01	01	H1019_117_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	118	0	1	01	01	H1019_118_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	118	0	1	01	01	H1019_118_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	118	0	1	01	01	H1019_118_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	118	0	1	01	01	H1019_118_0	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	118	0	1	01	01	H1019_118_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	118	0	1	01	01	H1019_118_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	118	0	1	01	01	H1019_118_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	120	1	1	01	01	H1019_120_1	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	120	1	1	01	01	H1019_120_1	3	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	120	1	1	01	01	H1019_120_1	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	120	1	1	01	01	H1019_120_1	3	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	120	1	1	01	01	H1019_120_1	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	120	1	1	01	01	H1019_120_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	120	1	1	01	01	H1019_120_1	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	120	2	1	01	01	H1019_120_2	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	120	2	1	01	01	H1019_120_2	3	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	120	2	1	01	01	H1019_120_2	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	120	2	1	01	01	H1019_120_2	3	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	120	2	1	01	01	H1019_120_2	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	120	2	1	01	01	H1019_120_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	120	2	1	01	01	H1019_120_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	040	0	1	01	01	H1032_040_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	040	0	1	01	01	H1032_040_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	040	0	1	01	01	H1032_040_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								25.00	50.00	75.00					15.00	30.00	45.00											25.00	50.00	75.00				15.00	30.00	30.00				25.00				25.00			0.83	0.5		0.83	0.5	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	040	0	1	01	01	H1032_040_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								50.00	100.00	150.00					40.00	80.00	120.00											50.00	100.00	150.00				40.00	80.00	80.00				50.00				50.00			1.67	1.33		1.67	1.33	1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	040	0	1	01	01	H1032_040_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	040	0	1	01	01	H1032_040_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	040	0	1	01	01	H1032_040_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	124	0	1	01	01	H1032_124_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	124	0	1	01	01	H1032_124_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	124	0	1	01	01	H1032_124_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	124	0	1	01	01	H1032_124_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				95.02	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	124	0	1	01	01	H1032_124_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	124	0	1	01	01	H1032_124_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	170	0	1	01	01	H1032_170_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	170	0	1	01	01	H1032_170_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	170	0	1	01	01	H1032_170_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	170	0	1	01	01	H1032_170_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.87	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	170	0	1	01	01	H1032_170_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	170	0	1	01	01	H1032_170_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	175	0	1	01	01	H1032_175_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	175	0	1	01	01	H1032_175_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	175	0	1	01	01	H1032_175_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	175	0	1	01	01	H1032_175_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				93.01	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	175	0	1	01	01	H1032_175_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	175	0	1	01	01	H1032_175_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	176	0	1	01	01	H1032_176_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	176	0	1	01	01	H1032_176_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	176	0	1	01	01	H1032_176_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	176	0	1	01	01	H1032_176_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.39	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	176	0	1	01	01	H1032_176_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	176	0	1	01	01	H1032_176_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	182	0	1	01	01	H1032_182_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	182	0	1	01	01	H1032_182_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	182	0	1	01	01	H1032_182_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	182	0	1	01	01	H1032_182_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.06	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	182	0	1	01	01	H1032_182_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	182	0	1	01	01	H1032_182_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	184	0	1	01	01	H1032_184_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	184	0	1	01	01	H1032_184_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2	2	3
H1032	184	0	1	01	01	H1032_184_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H1032	184	0	1	01	01	H1032_184_0	5	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		
H1032	184	0	1	01	01	H1032_184_0	5	Preferred Brand	4	11	1	2	3	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												
H1032	184	0	1	01	01	H1032_184_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								75.00	150.00	225.00					65.00	130.00	195.00											75.00	150.00	225.00				65.00	130.00	130.00				75.00				75.00			2.5	2.17		2.5	2.17	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	184	0	1	01	01	H1032_184_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	184	0	1	01	01	H1032_184_0	5	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H1032	184	0	1	01	01	H1032_184_0	5	Select Diabetic Drugs	4	10	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 Diabetic Drugs										2		
H1032	186	0	1	01	01	H1032_186_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	186	0	1	01	01	H1032_186_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2	2	3
H1032	186	0	1	01	01	H1032_186_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H1032	186	0	1	01	01	H1032_186_0	5	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		
H1032	186	0	1	01	01	H1032_186_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H1032	186	0	1	01	01	H1032_186_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								50.00	100.00	150.00					40.00	80.00	120.00											50.00	100.00	150.00				40.00	80.00	80.00				50.00				50.00			1.67	1.33		1.67	1.33	1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	186	0	1	01	01	H1032_186_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	186	0	1	01	01	H1032_186_0	5	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H1032	186	0	1	01	01	H1032_186_0	5	Select Diabetic Drugs	4	10	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 Diabetic Drugs										2		
H1032	189	0	1	01	01	H1032_189_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	189	0	1	01	01	H1032_189_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	189	0	1	01	01	H1032_189_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1032	189	0	1	01	01	H1032_189_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H1032	189	0	1	01	01	H1032_189_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1032	189	0	1	01	01	H1032_189_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	189	0	1	01	01	H1032_189_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	189	0	1	01	01	H1032_189_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	190	0	1	01	01	H1032_190_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	190	0	1	01	01	H1032_190_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	190	0	1	01	01	H1032_190_0	5	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					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												
H1032	190	0	1	01	01	H1032_190_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H1032	190	0	1	01	01	H1032_190_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1032	190	0	1	01	01	H1032_190_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	190	0	1	01	01	H1032_190_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	190	0	1	01	01	H1032_190_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	191	0	1	01	01	H1032_191_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	191	0	1	01	01	H1032_191_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	191	0	1	01	01	H1032_191_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1032	191	0	1	01	01	H1032_191_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H1032	191	0	1	01	01	H1032_191_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1032	191	0	1	01	01	H1032_191_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	191	0	1	01	01	H1032_191_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	191	0	1	01	01	H1032_191_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	192	0	1	01	01	H1032_192_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	192	0	1	01	01	H1032_192_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	192	0	1	01	01	H1032_192_0	5	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					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												
H1032	192	0	1	01	01	H1032_192_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H1032	192	0	1	01	01	H1032_192_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.00	46	46	46				94.70	44	44	44										46	46	46				44	44	44			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	192	0	1	01	01	H1032_192_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	192	0	1	01	01	H1032_192_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	192	0	1	01	01	H1032_192_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	193	0	1	01	01	H1032_193_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	193	0	1	01	01	H1032_193_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	193	0	1	01	01	H1032_193_0	5	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					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												
H1032	193	0	1	01	01	H1032_193_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					30.00	60.00	90.00											40.00	80.00	120.00				30.00	60.00	60.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	193	0	1	01	01	H1032_193_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	240.00											90.00	180.00	270.00				80.00	160.00	160.00				90.00				90.00			3.00	2.67		3.00	2.67	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	193	0	1	01	01	H1032_193_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	193	0	1	01	01	H1032_193_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	193	0	1	01	01	H1032_193_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	194	0	1	01	01	H1032_194_0	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	194	0	1	01	01	H1032_194_0	6	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	194	0	1	01	01	H1032_194_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	194	0	1	01	01	H1032_194_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H1032	194	0	1	01	01	H1032_194_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								75.00	150.00	225.00					65.00	130.00	195.00											75.00	150.00	225.00				65.00	130.00	130.00				75.00				75.00			2.5	2.17		2.5	2.17	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	194	0	1	01	01	H1032_194_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	194	0	1	01	01	H1032_194_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	194	0	1	01	01	H1032_194_0	6	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	195	0	1	01	01	H1032_195_0	7	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	195	0	1	01	01	H1032_195_0	7	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	195	0	1	01	01	H1032_195_0	7	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					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												
H1032	195	0	1	01	01	H1032_195_0	7	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											40.00	80.00	120.00				30.00	60.00	60.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	195	0	1	01	01	H1032_195_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	240.00											90.00	180.00	270.00				80.00	160.00	160.00				90.00				90.00			3.00	2.67		3.00	2.67	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	195	0	1	01	01	H1032_195_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	195	0	1	01	01	H1032_195_0	7	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	195	0	1	01	01	H1032_195_0	7	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	196	0	1	01	01	H1032_196_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	196	0	1	01	01	H1032_196_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	196	0	1	01	01	H1032_196_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	196	0	1	01	01	H1032_196_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H1032	196	0	1	01	01	H1032_196_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								75.00	150.00	225.00					65.00	130.00	195.00											75.00	150.00	225.00				65.00	130.00	130.00				75.00				75.00			2.5	2.17		2.5	2.17	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	196	0	1	01	01	H1032_196_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	196	0	1	01	01	H1032_196_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	196	0	1	01	01	H1032_196_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	198	0	1	01	01	H1032_198_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	198	0	1	01	01	H1032_198_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	198	0	1	01	01	H1032_198_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	198	0	1	01	01	H1032_198_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H1032	198	0	1	01	01	H1032_198_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	240.00											90.00	180.00	270.00				80.00	160.00	160.00				90.00				90.00			3.00	2.67		3.00	2.67	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	198	0	1	01	01	H1032_198_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	198	0	1	01	01	H1032_198_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	198	0	1	01	01	H1032_198_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	199	0	1	01	01	H1032_199_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	199	0	1	01	01	H1032_199_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	199	0	1	01	01	H1032_199_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	199	0	1	01	01	H1032_199_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H1032	199	0	1	01	01	H1032_199_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								75.00	150.00	225.00					65.00	130.00	195.00											75.00	150.00	225.00				65.00	130.00	130.00				75.00				75.00			2.5	2.17		2.5	2.17	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	199	0	1	01	01	H1032_199_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	199	0	1	01	01	H1032_199_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	199	0	1	01	01	H1032_199_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	200	0	1	01	01	H1032_200_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	200	0	1	01	01	H1032_200_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	200	0	1	01	01	H1032_200_0	5	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					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												
H1032	200	0	1	01	01	H1032_200_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H1032	200	0	1	01	01	H1032_200_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								80.00	160.00	240.00					70.00	140.00	210.00											80.00	160.00	240.00				70.00	140.00	140.00				80.00				80.00			2.67	2.33		2.67	2.33	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	200	0	1	01	01	H1032_200_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	200	0	1	01	01	H1032_200_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	200	0	1	01	01	H1032_200_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	201	0	1	01	01	H1032_201_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	201	0	1	01	01	H1032_201_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	201	0	1	01	01	H1032_201_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	201	0	1	01	01	H1032_201_0	5	Preferred Brand	4	11	1	2	3	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												
H1032	201	0	1	01	01	H1032_201_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								75.00	150.00	225.00					65.00	130.00	195.00											75.00	150.00	225.00				65.00	130.00	130.00				75.00				75.00			2.5	2.17		2.5	2.17	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	201	0	1	01	01	H1032_201_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	201	0	1	01	01	H1032_201_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	201	0	1	01	01	H1032_201_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	202	0	1	01	01	H1032_202_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	202	0	1	01	01	H1032_202_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	202	0	1	01	01	H1032_202_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	120.00																									40.00	80.00	120.00				40.00	80.00	80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	202	0	1	01	01	H1032_202_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.35	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	202	0	1	01	01	H1032_202_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	202	0	1	01	01	H1032_202_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	203	0	1	01	01	H1032_203_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	203	0	1	01	01	H1032_203_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2	2	3
H1032	203	0	1	01	01	H1032_203_0	5	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					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	203	0	1	01	01	H1032_203_0	5	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	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H1032	203	0	1	01	01	H1032_203_0	5	Preferred Brand	4	11	1	2	3	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												
H1032	203	0	1	01	01	H1032_203_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								80.00	160.00	240.00					70.00	140.00	210.00											80.00	160.00	240.00				70.00	140.00	140.00				80.00				80.00			2.67	2.33		2.67	2.33	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	203	0	1	01	01	H1032_203_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	203	0	1	01	01	H1032_203_0	5	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H1032	203	0	1	01	01	H1032_203_0	5	Select Diabetic Drugs	4	10	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 Diabetic Drugs										2		
H1032	204	0	1	01	01	H1032_204_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	204	0	1	01	01	H1032_204_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	204	0	1	01	01	H1032_204_0	5	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					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												
H1032	204	0	1	01	01	H1032_204_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H1032	204	0	1	01	01	H1032_204_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.21	43	43	43				94.59	41	41	41										43	43	43				41	41	41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	204	0	1	01	01	H1032_204_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	204	0	1	01	01	H1032_204_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	204	0	1	01	01	H1032_204_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	205	0	1	01	01	H1032_205_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	205	0	1	01	01	H1032_205_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	205	0	1	01	01	H1032_205_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	205	0	1	01	01	H1032_205_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H1032	205	0	1	01	01	H1032_205_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.49	50	50	50				95.51	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	205	0	1	01	01	H1032_205_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	205	0	1	01	01	H1032_205_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	205	0	1	01	01	H1032_205_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	206	0	1	01	01	H1032_206_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	206	0	1	01	01	H1032_206_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	206	0	1	01	01	H1032_206_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	206	0	1	01	01	H1032_206_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.17	41	41	41																								41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	206	0	1	01	01	H1032_206_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	206	0	1	01	01	H1032_206_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	209	0	1	01	01	H1032_209_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	209	0	1	01	01	H1032_209_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	209	0	1	01	01	H1032_209_0	5	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					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												
H1032	209	0	1	01	01	H1032_209_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H1032	209	0	1	01	01	H1032_209_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.49	41	41	41				93.68	39	39	39										41	41	41				39	39	39			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	209	0	1	01	01	H1032_209_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	209	0	1	01	01	H1032_209_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	209	0	1	01	01	H1032_209_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	210	0	1	01	01	H1032_210_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	210	0	1	01	01	H1032_210_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	210	0	1	01	01	H1032_210_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	210	0	1	01	01	H1032_210_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					30.00	60.00	90.00											40.00	80.00	120.00				30.00	60.00	60.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	210	0	1	01	01	H1032_210_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	240.00											90.00	180.00	270.00				80.00	160.00	160.00				90.00				90.00			3.00	2.67		3.00	2.67	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	210	0	1	01	01	H1032_210_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	210	0	1	01	01	H1032_210_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	210	0	1	01	01	H1032_210_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	211	0	1	01	01	H1032_211_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	211	0	1	01	01	H1032_211_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	211	0	1	01	01	H1032_211_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	211	0	1	01	01	H1032_211_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H1032	211	0	1	01	01	H1032_211_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								75.00	150.00	225.00					65.00	130.00	195.00											75.00	150.00	225.00				65.00	130.00	130.00				75.00				75.00			2.5	2.17		2.5	2.17	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	211	0	1	01	01	H1032_211_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	211	0	1	01	01	H1032_211_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	211	0	1	01	01	H1032_211_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	212	0	1	01	01	H1032_212_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	212	0	1	01	01	H1032_212_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	212	0	1	01	01	H1032_212_0	5	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					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												
H1032	212	0	1	01	01	H1032_212_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H1032	212	0	1	01	01	H1032_212_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								95.00	190.00	285.00					85.00	170.00	255.00											95.00	190.00	285.00				85.00	170.00	170.00				95.00				95.00			3.17	2.83		3.17	2.83	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	212	0	1	01	01	H1032_212_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	212	0	1	01	01	H1032_212_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	212	0	1	01	01	H1032_212_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	213	0	1	01	01	H1032_213_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	213	0	1	01	01	H1032_213_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	213	0	1	01	01	H1032_213_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	213	0	1	01	01	H1032_213_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H1032	213	0	1	01	01	H1032_213_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								75.00	150.00	225.00					65.00	130.00	195.00											75.00	150.00	225.00				65.00	130.00	130.00				75.00				75.00			2.5	2.17		2.5	2.17	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	213	0	1	01	01	H1032_213_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	213	0	1	01	01	H1032_213_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	213	0	1	01	01	H1032_213_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	214	0	1	01	01	H1032_214_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	214	0	1	01	01	H1032_214_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	214	0	1	01	01	H1032_214_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	214	0	1	01	01	H1032_214_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.03	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	214	0	1	01	01	H1032_214_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	214	0	1	01	01	H1032_214_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	217	0	1	01	01	H1032_217_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	217	0	1	01	01	H1032_217_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	217	0	1	01	01	H1032_217_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	217	0	1	01	01	H1032_217_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.46	39	39	39																								39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	217	0	1	01	01	H1032_217_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	217	0	1	01	01	H1032_217_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	218	0	1	01	01	H1032_218_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	218	0	1	01	01	H1032_218_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	218	0	1	01	01	H1032_218_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1032	218	0	1	01	01	H1032_218_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H1032	218	0	1	01	01	H1032_218_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	297.00					89.00	178.00	267.00											99.00	198.00	297.00				89.00	178.00	178.00				99.00				99.00			3.3	2.97		3.3	2.97	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	218	0	1	01	01	H1032_218_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	218	0	1	01	01	H1032_218_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	218	0	1	01	01	H1032_218_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	224	0	1	01	01	H1032_224_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	224	0	1	01	01	H1032_224_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2	2	3
H1032	224	0	1	01	01	H1032_224_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H1032	224	0	1	01	01	H1032_224_0	5	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		
H1032	224	0	1	01	01	H1032_224_0	5	Preferred Brand	4	11	1	2	3	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												
H1032	224	0	1	01	01	H1032_224_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								75.00	150.00	225.00					65.00	130.00	195.00											75.00	150.00	225.00				65.00	130.00	130.00				75.00				75.00			2.5	2.17		2.5	2.17	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	224	0	1	01	01	H1032_224_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	224	0	1	01	01	H1032_224_0	5	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					10.00	20.00	30.00											10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	224	0	1	01	01	H1032_224_0	5	Select Diabetic Drugs	4	10	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					10.00	20.00	30.00											10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2		
H1032	227	0	1	01	01	H1032_227_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	227	0	1	01	01	H1032_227_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2	2	3
H1032	227	0	1	01	01	H1032_227_0	5	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					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	227	0	1	01	01	H1032_227_0	5	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	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H1032	227	0	1	01	01	H1032_227_0	5	Preferred Brand	4	11	1	2	3	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												
H1032	227	0	1	01	01	H1032_227_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								80.00	160.00	240.00					70.00	140.00	210.00											80.00	160.00	240.00				70.00	140.00	140.00				80.00				80.00			2.67	2.33		2.67	2.33	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	227	0	1	01	01	H1032_227_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	227	0	1	01	01	H1032_227_0	5	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					10.00	20.00	30.00											10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	227	0	1	01	01	H1032_227_0	5	Select Diabetic Drugs	4	10	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					10.00	20.00	30.00											10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2		
H1032	236	0	1	01	01	H1032_236_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	236	0	1	01	01	H1032_236_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	236	0	1	01	01	H1032_236_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	236	0	1	01	01	H1032_236_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.64	39	39	39																								39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	236	0	1	01	01	H1032_236_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	236	0	1	01	01	H1032_236_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	002	0	1	02	01	H1035_002_0	6	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	6	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	6	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	6	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	6	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	6	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	6	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	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	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	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	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	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1563.71	33						1563.71	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	018	0	1	01	01	H1035_018_0	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1520.04	33						1520.04	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	5	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	5	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	7	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1557.06	33						1557.06	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	7	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	7	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	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1605.37	33						1605.37	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1554.31	33						1554.31	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1571.78	33						1571.78	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	023	0	1	01	01	H1035_023_0	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1504.97	33						1504.97	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	024	0	1	01	01	H1035_024_0	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1586.73	33						1586.73	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	025	0	1	01	01	H1035_025_0	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1456.58	33						1456.58	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	026	0	1	01	01	H1035_026_0	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1515.02	33						1515.02	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	027	0	1	01	01	H1035_027_0	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1182.39	25						1182.39	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	028	0	1	01	01	H1035_028_0	10	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	10	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	10	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											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	10	Generic	4	01	1	2	2	3		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											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	10	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					40.00		120.00											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	10	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	10	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1175.42	25						1175.42	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	029	0	1	01	01	H1035_029_0	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1163.40	25						1163.40	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	030	0	1	01	01	H1035_030_0	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1175.51	25						1175.51	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	031	0	1	01	01	H1035_031_0	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1161.00	25						1161.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	032	0	1	01	01	H1035_032_0	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1165.84	25						1165.84	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	033	0	1	01	01	H1035_033_0	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1516.25	33						1516.25	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	034	0	1	01	01	H1035_034_0	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1474.95	33						1474.95	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	035	0	1	01	01	H1035_035_0	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1408.61	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	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1411.57	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	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1407.61	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	5	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	5	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	5	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	039	0	1	01	01	H1035_039_0	5	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	039	0	1	01	01	H1035_039_0	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	25.00		75.00																			25.00		75.00																25.00				25.00		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	5	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1448.08	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	040	0	1	01	01	H1035_040_0	7	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	7	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	7	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	7	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	7	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	7	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	7	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	5	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	5	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	5	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	5	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	5	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	043	0	1	01	01	H1035_043_0	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1508.67	33						1508.67	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	045	0	1	01	01	H1035_045_0	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1518.85	33						1518.85	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	046	0	1	01	01	H1035_046_0	5	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	046	0	1	01	01	H1035_046_0	5	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	046	0	1	01	01	H1035_046_0	5	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					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	046	0	1	01	01	H1035_046_0	5	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	046	0	1	01	01	H1035_046_0	5	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	046	0	1	01	01	H1035_046_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1556.42	33						1556.42	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	046	0	1	01	01	H1035_046_0	5	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	046	0	1	01	01	H1035_046_0	5	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	047	0	1	01	01	H1035_047_0	5	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	047	0	1	01	01	H1035_047_0	5	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	047	0	1	01	01	H1035_047_0	5	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					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	047	0	1	01	01	H1035_047_0	5	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	047	0	1	01	01	H1035_047_0	5	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	047	0	1	01	01	H1035_047_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1560.90	33						1560.90	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	047	0	1	01	01	H1035_047_0	5	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	047	0	1	01	01	H1035_047_0	5	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	048	0	1	01	01	H1035_048_0	6	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	048	0	1	01	01	H1035_048_0	6	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	048	0	1	01	01	H1035_048_0	6	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	048	0	1	01	01	H1035_048_0	6	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	048	0	1	01	01	H1035_048_0	6	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	048	0	1	01	01	H1035_048_0	6	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	048	0	1	01	01	H1035_048_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1504.63	33						1504.63	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	6	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	6	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	9	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		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	9	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	9	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	9	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	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		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	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	6	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	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	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					15.00		45.00											47.00		141.00				15.00		35.00				47.00				47.00			1.57	0.50		1.57	0.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	6	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	6	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	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	6	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		95.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	074	0	1	01	01	H1036_074_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	074	0	1	01	01	H1036_074_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					10.00		30.00											47.00		141.00				10.00		20.00				47.00				47.00			1.57	0.33		1.57	0.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					60.00		180.00											100.00		300.00				60.00		170.00				100.00				100.00			3.33	2		3.33	2	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	7	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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		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	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	6	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	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	6	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	121	0	1	01	01	H1036_121_0	6	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	121	0	1	01	01	H1036_121_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								45.00		135.00					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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	140	0	1	01	01	H1036_140_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	140	0	1	01	01	H1036_140_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					75.00		225.00											100.00		300.00				75.00		215.00				100.00				100.00			3.33	2.50		3.33	2.50	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	6	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	6	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	6	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	6	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	6	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	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	146	0	1	01	01	H1036_146_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	146	0	1	01	01	H1036_146_0	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	146	0	1	01	01	H1036_146_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	156	0	1	01	01	H1036_156_0	8	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	8	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	156	0	1	01	01	H1036_156_0	8	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	8	Non-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	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	8	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	8	Select Care Drugs	4	11	1	2	6	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	157	0	1	01	01	H1036_157_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	4	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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	160	0	1	01	01	H1036_160_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	160	0	1	01	01	H1036_160_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	4	Non-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	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	4	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												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	4	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	4	Select Care Drugs	4	11	1	2	6	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	167	0	1	01	01	H1036_167_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								4.00		12.00					3.00		9.00											4.00		12.00				3.00		0.00				4.00				4.00			0.13	0.10		0.13	0.10	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								18.00		54.00					15.00		45.00											18.00		54.00				15.00		0.00				18.00				18.00			0.60	0.50		0.60	0.50	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					3.00		9.00											5.00		15.00				3.00		0.00				5.00				5.00			0.17	0.10		0.17	0.10	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	175	0	1	01	01	H1036_175_0	8	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	8	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	175	0	1	01	01	H1036_175_0	8	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	175	0	1	01	01	H1036_175_0	8	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	175	0	1	01	01	H1036_175_0	8	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	8	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	8	Non-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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	8	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	8	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	8	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	199	0	1	01	01	H1036_199_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	217	0	1	01	01	H1036_217_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	217	0	1	01	01	H1036_217_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	4	Preferred Generic	4	11	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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_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					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	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	7	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	7	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	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	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												
H1036	230	0	1	01	01	H1036_230_0	7	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	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										1		
H1036	230	0	1	01	01	H1036_230_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	Non-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	Specialty Tier	4	11	1	1	5	1		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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	7	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	235	0	1	01	01	H1036_235_0	8	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												
H1036	235	0	1	01	01	H1036_235_0	8	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	235	0	1	01	01	H1036_235_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	262	0	1	01	01	H1036_262_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	262	0	1	01	01	H1036_262_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	262	0	1	01	01	H1036_262_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	4	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	265	1	1	01	01	H1036_265_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	265	1	1	01	01	H1036_265_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	265	2	1	01	01	H1036_265_2	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	265	2	1	01	01	H1036_265_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	4	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	268	0	1	01	01	H1036_268_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	268	0	1	01	01	H1036_268_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	269	0	1	01	01	H1036_269_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	4	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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					4.00		12.00											19.00		57.00				4.00		0.00				19.00				19.00			0.63	0.13		0.63	0.13	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	276	0	1	01	01	H1036_276_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	276	0	1	01	01	H1036_276_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	276	0	1	01	01	H1036_276_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	276	0	1	01	01	H1036_276_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	278	0	1	01	01	H1036_278_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	283	0	1	01	01	H1036_283_0	7	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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	283	0	1	01	01	H1036_283_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		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	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	284	0	1	01	01	H1036_284_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	284	0	1	01	01	H1036_284_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	284	0	1	01	01	H1036_284_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	286	0	1	01	01	H1036_286_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	286	0	1	01	01	H1036_286_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	286	0	1	01	01	H1036_286_0	4	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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	01	01	H1036_291_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	01	01	H1036_291_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	01	01	H1036_291_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	01	01	H1036_291_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	01	01	H1036_291_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	292	0	1	01	01	H1036_292_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	292	0	1	01	01	H1036_292_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	292	0	1	01	01	H1036_292_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		95.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	292	0	1	01	01	H1036_292_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	292	0	1	01	01	H1036_292_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	294	0	1	01	01	H1036_294_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	294	0	1	01	01	H1036_294_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	294	0	1	01	01	H1036_294_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	294	0	1	01	01	H1036_294_0	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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										2	3	
H1036	294	0	1	01	01	H1036_294_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		95.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	294	0	1	01	01	H1036_294_0	5	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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, Select Care Drugs										2	3	
H1036	294	0	1	01	01	H1036_294_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	294	0	1	01	01	H1036_294_0	5	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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, Select Care Drugs										2	3	
H1036	294	0	1	01	01	H1036_294_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	294	0	1	01	01	H1036_294_0	5	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	294	0	1	01	01	H1036_294_0	5	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	294	0	1	01	01	H1036_294_0	5	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	295	0	1	01	01	H1036_295_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	295	0	1	01	01	H1036_295_0	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	295	0	1	01	01	H1036_295_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	295	0	1	01	01	H1036_295_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	295	0	1	01	01	H1036_295_0	4	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	295	0	1	01	01	H1036_295_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		260.00				100.00				100.00			3.33	3		3.33	3	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	295	0	1	01	01	H1036_295_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	296	0	1	01	01	H1036_296_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	296	0	1	01	01	H1036_296_0	6	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	296	0	1	01	01	H1036_296_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	296	0	1	01	01	H1036_296_0	6	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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										2	3	
H1036	296	0	1	01	01	H1036_296_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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, Select Care Drugs												
H1036	296	0	1	01	01	H1036_296_0	6	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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, Select Care Drugs										2	3	
H1036	296	0	1	01	01	H1036_296_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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, Select Care Drugs												
H1036	296	0	1	01	01	H1036_296_0	6	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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, Select Care Drugs										2	3	
H1036	296	0	1	01	01	H1036_296_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	296	0	1	01	01	H1036_296_0	6	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	296	0	1	01	01	H1036_296_0	6	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	296	0	1	01	01	H1036_296_0	6	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		
H1045	001	0	1	01	01	H1045_001_0	3	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	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	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	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	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	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	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	005	0	1	01	01	H1045_005_0	3	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	3	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	3	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	3	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				344.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	3	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	3	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	3	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	3	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	3	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				2	2			100				30		31				44.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		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	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				289.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	3	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	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				248.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	025	0	1	01	01	H1045_025_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	025	0	1	01	01	H1045_025_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				436.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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	026	0	1	02	01	H1045_026_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	02	01	H1045_026_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	026	0	1	02	01	H1045_026_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	02	01	H1045_026_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	02	01	H1045_026_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				467.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	4	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	028	0	1	02	01	H1045_028_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	028	0	1	02	01	H1045_028_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	4	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												
H1045	030	0	1	02	01	H1045_030_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	02	01	H1045_030_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	030	0	1	02	01	H1045_030_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	02	01	H1045_030_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	030	0	1	02	01	H1045_030_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	02	01	H1045_030_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	02	01	H1045_030_0	3	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												
H1045	031	0	1	02	01	H1045_031_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	031	0	1	02	01	H1045_031_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	031	0	1	02	01	H1045_031_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				549.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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	032	0	1	02	01	H1045_032_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	02	01	H1045_032_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	032	0	1	02	01	H1045_032_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	02	01	H1045_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	02	01	H1045_032_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				479.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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	033	0	1	01	01	H1045_033_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	033	0	1	01	01	H1045_033_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				439.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	034	0	1	01	01	H1045_034_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	034	0	1	01	01	H1045_034_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				479.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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	036	0	1	02	01	H1045_036_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	02	01	H1045_036_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	036	0	1	02	01	H1045_036_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	02	01	H1045_036_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	02	01	H1045_036_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				457.00	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	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	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	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	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	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	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	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												
H1045	041	0	1	02	01	H1045_041_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	041	0	1	02	01	H1045_041_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	041	0	1	02	01	H1045_041_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	3	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												
H1045	042	0	1	02	01	H1045_042_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	042	0	1	02	01	H1045_042_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	042	0	1	02	01	H1045_042_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				593.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	02	01	H1045_043_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	043	0	1	02	01	H1045_043_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	02	01	H1045_043_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	043	0	1	02	01	H1045_043_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	02	01	H1045_043_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	02	01	H1045_043_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				437.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	045	0	1	02	01	H1045_045_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	045	0	1	02	01	H1045_045_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				425.00	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	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	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		
H1045	048	1	1	01	01	H1045_048_1	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											209.00	30						208.00	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	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	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		
H1045	048	2	1	01	01	H1045_048_2	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											209.00	30						208.00	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	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	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		
H1045	048	3	1	01	01	H1045_048_3	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											209.00	30						208.00	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	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	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		
H1045	048	4	1	01	01	H1045_048_4	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											209.00	30						208.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	055	0	1	01	01	H1045_055_0	3	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	055	0	1	01	01	H1045_055_0	3	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	055	0	1	01	01	H1045_055_0	3	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	055	0	1	01	01	H1045_055_0	3	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	055	0	1	01	01	H1045_055_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	055	0	1	01	01	H1045_055_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	055	0	1	01	01	H1045_055_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				344.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	8	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	8	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1099	001	0	1	02	01	H1099_001_0	8	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					10.00		30.00							30.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	8	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					10.00		30.00							30.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1099	001	0	1	02	01	H1099_001_0	8	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							112.50																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								90.00		270.00					80.00		240.00							225.00																90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	8	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											2068.22	33						853.71	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	8	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	8	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1099	006	0	1	01	01	H1099_006_0	8	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					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												
H1099	006	0	1	01	01	H1099_006_0	8	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							112.50																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								90.00		270.00					80.00		240.00							225.00																90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	8	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1834.76	33						729.43	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	014	0	1	01	01	H1099_014_0	8	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	014	0	1	01	01	H1099_014_0	8	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1099	014	0	1	01	01	H1099_014_0	8	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					10.00		30.00							30.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	014	0	1	01	01	H1099_014_0	8	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							112.50																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	014	0	1	01	01	H1099_014_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								90.00		270.00					80.00		240.00							225.00																90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	014	0	1	01	01	H1099_014_0	8	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1745.01	33						683.63	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	016	0	1	01	01	H1099_016_0	8	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	016	0	1	01	01	H1099_016_0	8	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1099	016	0	1	01	01	H1099_016_0	8	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												
H1099	016	0	1	01	01	H1099_016_0	8	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					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												
H1099	016	0	1	01	01	H1099_016_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					90.00		270.00							225.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	016	0	1	01	01	H1099_016_0	8	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1898.05	33						724.54	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											707.60	28						322.43	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	006	0	1	01	01	H1109_006_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	006	0	1	01	01	H1109_006_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	006	0	1	01	01	H1109_006_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	006	0	1	01	01	H1109_006_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	006	0	1	01	01	H1109_006_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											901.86	30						420.42	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	011	0	1	01	01	H1111_011_0	3	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	011	0	1	01	01	H1111_011_0	3	Preferred Generic	4	01	1	2	1	3		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										1		
H1111	011	0	1	01	01	H1111_011_0	3	Generic	4	01	3	2	2	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												
H1111	011	0	1	01	01	H1111_011_0	3	Generic	4	01	3	2	2	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										2		2
H1111	011	0	1	01	01	H1111_011_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					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	011	0	1	01	01	H1111_011_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								95.00		285.00					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	011	0	1	01	01	H1111_011_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											350.00	28						256.00	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	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	006	0	1	01	01	H1112_006_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	006	0	1	01	01	H1112_006_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	006	0	1	01	01	H1112_006_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.92	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	006	0	1	01	01	H1112_006_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	006	0	1	01	01	H1112_006_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	033	0	1	01	01	H1112_033_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	033	0	1	01	01	H1112_033_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	033	0	1	01	01	H1112_033_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	120.00																									40.00	80.00	120.00				40.00	80.00	80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	033	0	1	01	01	H1112_033_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.59	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	033	0	1	01	01	H1112_033_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	033	0	1	01	01	H1112_033_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	035	0	1	01	01	H1112_035_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	035	0	1	01	01	H1112_035_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1112	035	0	1	01	01	H1112_035_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H1112	035	0	1	01	01	H1112_035_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1112	035	0	1	01	01	H1112_035_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	035	0	1	01	01	H1112_035_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	035	0	1	01	01	H1112_035_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1112	037	0	1	01	01	H1112_037_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1112	037	0	1	01	01	H1112_037_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2	2	3
H1112	037	0	1	01	01	H1112_037_0	4	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					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1112	037	0	1	01	01	H1112_037_0	4	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	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H1112	037	0	1	01	01	H1112_037_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								25.00	50.00	75.00					15.00	30.00	45.00											25.00	50.00	75.00				15.00	30.00	30.00				25.00				25.00			0.83	0.5		0.83	0.5	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1112	037	0	1	01	01	H1112_037_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Diabetic Drugs												
H1112	037	0	1	01	01	H1112_037_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1112	037	0	1	01	01	H1112_037_0	4	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					10.00	20.00	30.00											10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1112	037	0	1	01	01	H1112_037_0	4	Select Diabetic Drugs	4	10	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					10.00	20.00	30.00											10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2		
H1112	038	0	1	01	01	H1112_038_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	038	0	1	01	01	H1112_038_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1112	038	0	1	01	01	H1112_038_0	4	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					34.00	68.00	102.00											44.00	88.00	132.00				34.00	68.00	68.00				44.00				44.00			1.47	1.13		1.47	1.13	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	038	0	1	01	01	H1112_038_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.05	37	37	37				92.75	35	35	35										37	37	37				35	35	35			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	038	0	1	01	01	H1112_038_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	038	0	1	01	01	H1112_038_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	038	0	1	01	01	H1112_038_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1112	039	0	1	01	01	H1112_039_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	039	0	1	01	01	H1112_039_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1112	039	0	1	01	01	H1112_039_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								44.00	88.00	132.00					34.00	68.00	102.00											44.00	88.00	132.00				34.00	68.00	68.00				44.00				44.00			1.47	1.13		1.47	1.13	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	039	0	1	01	01	H1112_039_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.56	43	43	43				93.98	41	41	41										43	43	43				41	41	41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	039	0	1	01	01	H1112_039_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	039	0	1	01	01	H1112_039_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	039	0	1	01	01	H1112_039_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1112	040	0	1	01	01	H1112_040_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	040	0	1	01	01	H1112_040_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1112	040	0	1	01	01	H1112_040_0	4	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					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												
H1112	040	0	1	01	01	H1112_040_0	4	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	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										1		
H1112	040	0	1	01	01	H1112_040_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H1112	040	0	1	01	01	H1112_040_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1112	040	0	1	01	01	H1112_040_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	040	0	1	01	01	H1112_040_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	040	0	1	01	01	H1112_040_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1112	042	0	1	01	01	H1112_042_0	4	Preferred Generic	4	11	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											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, Select Care Drugs												
H1112	042	0	1	01	01	H1112_042_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1112	042	0	1	01	01	H1112_042_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1112	042	0	1	01	01	H1112_042_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.48	38	38	38				93.29	36	36	36										38	38	38				36	36	36			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	042	0	1	01	01	H1112_042_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	042	0	1	01	01	H1112_042_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	043	0	1	01	01	H1112_043_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	043	0	1	01	01	H1112_043_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	043	0	1	01	01	H1112_043_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H1112	043	0	1	01	01	H1112_043_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.39	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	043	0	1	01	01	H1112_043_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	043	0	1	01	01	H1112_043_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	044	0	1	01	01	H1112_044_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	044	0	1	01	01	H1112_044_0	4	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					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												
H1112	044	0	1	01	01	H1112_044_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H1112	044	0	1	01	01	H1112_044_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1112	044	0	1	01	01	H1112_044_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	044	0	1	01	01	H1112_044_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	044	0	1	01	01	H1112_044_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1170	002	0	1	01	01	H1170_002_0	7	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	7	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	002	0	1	01	01	H1170_002_0	7	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	7	Generic	4	11	1	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 Brand, Specialty Tier, Vaccines										1		
H1170	002	0	1	01	01	H1170_002_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	7	Non-Preferred Brand	4	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	7	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 Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	008	0	1	01	01	H1170_008_0	9	Preferred Generic	4	11	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	008	0	1	01	01	H1170_008_0	9	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	0.00	0.00																14.00				14.00		0.46			0.46			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	9	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												
H1170	008	0	1	01	01	H1170_008_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	9	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	7	Preferred Generic	4	11	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	7	Preferred Generic	4	11	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	7	Generic	4	11	1	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 Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	7	Generic	4	11	1	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 Brand, Specialty Tier, Vaccines										1		
H1170	009	0	1	01	01	H1170_009_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	7	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	7	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 Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	010	0	1	01	01	H1170_010_0	7	Preferred Generic	4	11	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	010	0	1	01	01	H1170_010_0	7	Preferred Generic	4	11	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	010	0	1	01	01	H1170_010_0	7	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	010	0	1	01	01	H1170_010_0	7	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	010	0	1	01	01	H1170_010_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	010	0	1	01	01	H1170_010_0	7	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	010	0	1	01	01	H1170_010_0	7	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 Brand, Specialty Tier, Vaccines												
H1170	010	0	1	01	01	H1170_010_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	010	0	1	01	01	H1170_010_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	011	0	1	01	01	H1170_011_0	9	Preferred Generic	4	11	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	011	0	1	01	01	H1170_011_0	9	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	0.00	0.00																14.00				14.00		0.46			0.46			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	011	0	1	01	01	H1170_011_0	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	011	0	1	01	01	H1170_011_0	9	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												
H1170	011	0	1	01	01	H1170_011_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	011	0	1	01	01	H1170_011_0	9	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	012	0	1	01	01	H1170_012_0	7	Preferred Generic	4	11	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	012	0	1	01	01	H1170_012_0	7	Preferred Generic	4	11	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	012	0	1	01	01	H1170_012_0	7	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	012	0	1	01	01	H1170_012_0	7	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	012	0	1	01	01	H1170_012_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	012	0	1	01	01	H1170_012_0	7	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	012	0	1	01	01	H1170_012_0	7	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 Brand, Specialty Tier, Vaccines												
H1170	012	0	1	01	01	H1170_012_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	012	0	1	01	01	H1170_012_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1189	001	0	1	01	01	H1189_001_0	5	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	5	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	5	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	5	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		34				77.27	30		30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	001	0	1	01	01	H1189_001_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				770.03	29		29																				29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	002	0	1	01	01	H1189_002_0	5	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	5	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	5	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	5	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		34				79.95	30		30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	002	0	1	01	01	H1189_002_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				598.72	29		29																				29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	003	0	1	01	01	H1189_003_0	5	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	5	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	5	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	5	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		34				80.96	30		30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	003	0	1	01	01	H1189_003_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				804.97	29		29																				29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	004	0	1	01	01	H1189_004_0	5	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	5	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	5	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	5	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		34				67.16	26		26																				26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	004	0	1	01	01	H1189_004_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				758.11	29		29																				29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	005	0	1	01	01	H1189_005_0	5	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	005	0	1	01	01	H1189_005_0	5	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	005	0	1	01	01	H1189_005_0	5	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	005	0	1	01	01	H1189_005_0	5	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		34				67.16	26		26																				26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	005	0	1	01	01	H1189_005_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				758.11	29		29																				29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1215	001	0	1	01	01	H1215_001_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1215	001	0	1	01	01	H1215_001_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1215	001	0	1	01	01	H1215_001_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1215	001	0	1	01	01	H1215_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.51	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1215	001	0	1	01	01	H1215_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1215	001	0	1	01	01	H1215_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1215	002	0	1	01	01	H1215_002_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1215	002	0	1	01	01	H1215_002_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	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, Select Care Drugs												
H1215	002	0	1	01	01	H1215_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1215	002	0	1	01	01	H1215_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1215	002	0	1	01	01	H1215_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1215	002	0	1	01	01	H1215_002_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1215	003	0	1	01	01	H1215_003_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1215	003	0	1	01	01	H1215_003_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1215	003	0	1	01	01	H1215_003_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H1215	003	0	1	01	01	H1215_003_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.59	50	50	50				91.77	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1215	003	0	1	01	01	H1215_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1215	003	0	1	01	01	H1215_003_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1225	001	0	1	01	01	H1225_001_0	5	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												
H1225	001	0	1	01	01	H1225_001_0	5	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		
H1225	001	0	1	01	01	H1225_001_0	5	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	15.00	20.00																			10.00	15.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	001	0	1	01	01	H1225_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	70.50	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	001	0	1	01	01	H1225_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	001	0	1	01	01	H1225_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	003	0	1	01	01	H1225_003_0	5	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												
H1225	003	0	1	01	01	H1225_003_0	5	Generic	4	11	1	1	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				4.50	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	003	0	1	01	01	H1225_003_0	5	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				35.39	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	003	0	1	01	01	H1225_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				58.69	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	003	0	1	01	01	H1225_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				810.78	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1230	001	0	1	01	01	H1230_001_0	14	Preferred Generic	4	11	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	14	Preferred Generic	4	11	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	14	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	14	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	14	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	14	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	14	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 Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	14	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	14	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	11	Preferred Generic	4	11	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	11	Preferred Generic	4	11	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	11	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	11	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	11	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	11	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	11	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 Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	11	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	11	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	013	0	1	01	01	H1230_013_0	11	Preferred Generic	4	11	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	11	Preferred Generic	4	11	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	013	0	1	01	01	H1230_013_0	11	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	013	0	1	01	01	H1230_013_0	11	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	013	0	1	01	01	H1230_013_0	11	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	013	0	1	01	01	H1230_013_0	11	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	013	0	1	01	01	H1230_013_0	11	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 Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	11	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	11	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	014	0	1	01	01	H1230_014_0	11	Preferred Generic	4	11	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	11	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	11	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			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	11	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	014	0	1	01	01	H1230_014_0	11	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					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	11	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	11	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1248	001	0	1	04	01	H1248_001_0	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											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	8	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											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	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	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	8	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	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	8	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	8	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	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											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	8	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											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	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	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	8	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	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	8	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	8	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	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	9	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	9	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					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	9	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	9	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	9	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	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											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	8	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											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	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	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	8	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	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	8	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	8	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	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											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	8	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											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	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	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	8	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	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	8	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	8	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	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	9	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	9	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					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	9	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	9	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	9	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	007	0	1	04	01	H1248_007_0	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	007	0	1	04	01	H1248_007_0	9	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	007	0	1	04	01	H1248_007_0	9	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					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	007	0	1	04	01	H1248_007_0	9	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	007	0	1	04	01	H1248_007_0	9	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	007	0	1	04	01	H1248_007_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	007	0	1	04	01	H1248_007_0	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	29						473.52	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1277	001	0	1	01	01	H1277_001_0	6	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	6.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	001	0	1	01	01	H1277_001_0	6	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			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												
H1277	001	0	1	01	01	H1277_001_0	6	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												
H1277	001	0	1	01	01	H1277_001_0	6	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												
H1277	001	0	1	01	01	H1277_001_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				797.12	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	002	0	1	01	01	H1277_002_0	6	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	6.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	002	0	1	01	01	H1277_002_0	6	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			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												
H1277	002	0	1	01	01	H1277_002_0	6	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												
H1277	002	0	1	01	01	H1277_002_0	6	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												
H1277	002	0	1	01	01	H1277_002_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				797.12	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	3	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												
H1278	001	0	1	04	01	H1278_001_0	3	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		
H1278	001	0	1	04	01	H1278_001_0	3	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												
H1278	001	0	1	04	01	H1278_001_0	3	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
H1278	001	0	1	04	01	H1278_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				572.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	003	0	1	04	01	H1278_003_0	3	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												
H1278	003	0	1	04	01	H1278_003_0	3	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
H1278	003	0	1	04	01	H1278_003_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	3	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												
H1278	004	0	1	04	01	H1278_004_0	3	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												
H1278	004	0	1	04	01	H1278_004_0	3	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		
H1278	004	0	1	04	01	H1278_004_0	3	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												
H1278	004	0	1	04	01	H1278_004_0	3	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										1		3
H1278	004	0	1	04	01	H1278_004_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					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	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											288.00	27						232.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	005	0	1	04	01	H1278_005_0	3	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												
H1278	005	0	1	04	01	H1278_005_0	3	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
H1278	005	0	1	04	01	H1278_005_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	3	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												
H1278	007	0	1	04	01	H1278_007_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	007	0	1	04	01	H1278_007_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H1278	007	0	1	04	01	H1278_007_0	3	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												
H1278	007	0	1	04	01	H1278_007_0	3	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
H1278	007	0	1	04	01	H1278_007_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	007	0	1	04	01	H1278_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	007	0	1	04	01	H1278_007_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				407.00	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	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												
H1278	009	0	1	04	01	H1278_009_0	3	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		
H1278	009	0	1	04	01	H1278_009_0	3	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												
H1278	009	0	1	04	01	H1278_009_0	3	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
H1278	009	0	1	04	01	H1278_009_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	009	0	1	04	01	H1278_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	009	0	1	04	01	H1278_009_0	3	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												
H1278	010	0	1	04	01	H1278_010_0	3	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												
H1278	010	0	1	04	01	H1278_010_0	3	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		
H1278	010	0	1	04	01	H1278_010_0	3	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												
H1278	010	0	1	04	01	H1278_010_0	3	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
H1278	010	0	1	04	01	H1278_010_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	010	0	1	04	01	H1278_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	010	0	1	04	01	H1278_010_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				347.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H1278	013	0	1	04	01	H1278_013_0	3	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												
H1278	013	0	1	04	01	H1278_013_0	3	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
H1278	013	0	1	04	01	H1278_013_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				263.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H1278	014	0	1	04	01	H1278_014_0	3	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												
H1278	014	0	1	04	01	H1278_014_0	3	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
H1278	014	0	1	04	01	H1278_014_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	3	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												
H1278	015	0	1	04	01	H1278_015_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	015	0	1	04	01	H1278_015_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H1278	015	0	1	04	01	H1278_015_0	3	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												
H1278	015	0	1	04	01	H1278_015_0	3	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
H1278	015	0	1	04	01	H1278_015_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	015	0	1	04	01	H1278_015_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	015	0	1	04	01	H1278_015_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				364.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	016	0	1	04	01	H1278_016_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	016	0	1	04	01	H1278_016_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H1278	016	0	1	04	01	H1278_016_0	3	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												
H1278	016	0	1	04	01	H1278_016_0	3	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
H1278	016	0	1	04	01	H1278_016_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	016	0	1	04	01	H1278_016_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	016	0	1	04	01	H1278_016_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				389.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	020	0	1	04	01	H1278_020_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	020	0	1	04	01	H1278_020_0	3	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		
H1278	020	0	1	04	01	H1278_020_0	3	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												
H1278	020	0	1	04	01	H1278_020_0	3	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
H1278	020	0	1	04	01	H1278_020_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	020	0	1	04	01	H1278_020_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	020	0	1	04	01	H1278_020_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				379.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1280	001	0	1	01	01	H1280_001_0	19	Preferred Generic	4	01	1	2	1	1	110		10	110		1	30		100				1	2	30		100					10	31	0.00		0.00																			0.00		0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1280	001	0	1	01	01	H1280_001_0	19	Generic	4	01	1	2	2	1	110		10	110		1	30		100				1	2	30		100					10	31	5.00		15.00																			5.00		5.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1280	001	0	1	01	01	H1280_001_0	19	Preferred Brand	4	10	1	2	3	1	110		10	110		1	30		100				1	2	30		100					10	31	47.00		141.00																			47.00		47.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1280	001	0	1	01	01	H1280_001_0	19	Non-Preferred Drug	4	10	1	2	4	1	110		10	110		1	30		100				1	2	30		100					10	31	100.00		300.00																			100.00		300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1280	001	0	1	01	01	H1280_001_0	19	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				100.00	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1280	002	0	1	01	01	H1280_002_0	17	Preferred Generic	4	01	1	2	1	1	110		10	110		1	30		100				1	2	30		100					10	31	0.00		0.00																			0.00		0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1280	002	0	1	01	01	H1280_002_0	17	Generic	4	01	1	2	2	1	110		10	110		1	30		100				1	2	30		100					10	31	5.00		15.00																			5.00		5.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1280	002	0	1	01	01	H1280_002_0	17	Preferred Brand	4	10	1	2	3	1	110		10	110		1	30		100				1	2	30		100					10	31	47.00		141.00																			47.00		47.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1280	002	0	1	01	01	H1280_002_0	17	Non-Preferred Drug	4	10	1	2	4	1	110		10	110		1	30		100				1	2	30		100					10	31	100.00		300.00																			100.00		300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1280	002	0	1	01	01	H1280_002_0	17	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				100.00	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	001	0	1	01	01	H1290_001_0	11	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	11	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										2	2	
H1290	001	0	1	01	01	H1290_001_0	11	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	11	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										2	2	3
H1290	001	0	1	01	01	H1290_001_0	11	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	11	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	25.00	50.00	75.00																			25.00	50.00	75.00																25.00				25.00		0.83			0.83			0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	001	0	1	01	01	H1290_001_0	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				987.35	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	002	0	1	01	01	H1290_002_0	10	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	10	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										2	2	
H1290	002	0	1	01	01	H1290_002_0	10	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	10	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										2	2	3
H1290	002	0	1	01	01	H1290_002_0	10	Preferred Brand	4	11	1	2	3	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	002	0	1	01	01	H1290_002_0	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				850.35	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	003	0	1	01	01	H1290_003_0	10	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	10	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										2	2	
H1290	003	0	1	01	01	H1290_003_0	10	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	10	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										2	2	3
H1290	003	0	1	01	01	H1290_003_0	10	Preferred Brand	4	11	1	2	3	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	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	003	0	1	01	01	H1290_003_0	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1019.66	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	005	0	1	01	01	H1290_005_0	10	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	10	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										2	2	
H1290	005	0	1	01	01	H1290_005_0	10	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	10	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										2	2	3
H1290	005	0	1	01	01	H1290_005_0	10	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	25.00	50.00	75.00																			25.00	50.00	62.50																25.00				25.00		0.83			0.83			0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	005	0	1	01	01	H1290_005_0	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				959.87	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	013	0	1	01	01	H1290_013_0	10	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	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1146.24	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	014	0	1	01	01	H1290_014_0	10	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	10	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	014	0	1	01	01	H1290_014_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1023.87	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	015	0	1	01	01	H1290_015_0	10	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	10	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												
H1290	015	0	1	01	01	H1290_015_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1129.93	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	016	0	1	01	01	H1290_016_0	10	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	10	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												
H1290	016	0	1	01	01	H1290_016_0	10	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	10	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												
H1290	016	0	1	01	01	H1290_016_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				996.34	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	017	0	1	01	01	H1290_017_0	10	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	10	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												
H1290	017	0	1	01	01	H1290_017_0	10	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	10	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												
H1290	017	0	1	01	01	H1290_017_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1038.24	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	018	0	1	01	01	H1290_018_0	10	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	10	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												
H1290	018	0	1	01	01	H1290_018_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1162.33	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	019	0	1	01	01	H1290_019_0	13	Preferred Generic	4	11	3	1	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	019	0	1	01	01	H1290_019_0	13	Generic	4	11	1	1	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	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												
H1290	020	0	1	01	01	H1290_020_0	13	Preferred Generic	4	11	3	1	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	020	0	1	01	01	H1290_020_0	13	Generic	4	11	1	1	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	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												
H1290	021	0	1	01	01	H1290_021_0	13	Preferred Generic	4	11	3	1	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	13	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	021	0	1	01	01	H1290_021_0	13	Generic	4	11	1	1	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	13	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	13	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	13	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												
H1290	022	0	1	01	01	H1290_022_0	13	Preferred Generic	4	11	3	1	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	022	0	1	01	01	H1290_022_0	13	Generic	4	11	1	1	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	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												
H1290	023	0	1	01	01	H1290_023_0	13	Preferred Generic	4	11	3	1	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	023	0	1	01	01	H1290_023_0	13	Generic	4	11	1	1	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	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												
H1290	024	0	1	01	01	H1290_024_0	13	Preferred Generic	4	11	3	1	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	024	0	1	01	01	H1290_024_0	13	Generic	4	11	1	1	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					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	13	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												
H1290	025	0	1	01	01	H1290_025_0	10	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	10	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										2	2	
H1290	025	0	1	01	01	H1290_025_0	10	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	10	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										2	2	3
H1290	025	0	1	01	01	H1290_025_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				962.29	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	026	0	1	01	01	H1290_026_0	10	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	10	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										2	2	
H1290	026	0	1	01	01	H1290_026_0	10	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	10	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										2	2	3
H1290	026	0	1	01	01	H1290_026_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1042.27	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	027	0	1	01	01	H1290_027_0	10	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	10	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										2	2	
H1290	027	0	1	01	01	H1290_027_0	10	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	10	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										2	2	3
H1290	027	0	1	01	01	H1290_027_0	10	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	027	0	1	01	01	H1290_027_0	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				955.59	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	028	0	1	01	01	H1290_028_0	11	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	11	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										2	2	
H1290	028	0	1	01	01	H1290_028_0	11	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	11	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										2	2	3
H1290	028	0	1	01	01	H1290_028_0	11	Preferred Brand	4	11	1	2	3	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	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	028	0	1	01	01	H1290_028_0	11	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	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1051.52	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	029	0	1	01	01	H1290_029_0	10	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	10	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										2	2	
H1290	029	0	1	01	01	H1290_029_0	10	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	10	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										2	2	3
H1290	029	0	1	01	01	H1290_029_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				957.82	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	030	0	1	01	01	H1290_030_0	10	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	10	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										2	2	
H1290	030	0	1	01	01	H1290_030_0	10	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	10	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										2	2	3
H1290	030	0	1	01	01	H1290_030_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1047.06	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	031	0	1	01	01	H1290_031_0	11	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	11	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	031	0	1	01	01	H1290_031_0	11	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	11	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	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1083.97	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	032	0	1	01	01	H1290_032_0	10	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	10	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	032	0	1	01	01	H1290_032_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1098.40	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	033	0	1	01	01	H1290_033_0	13	Preferred Generic	4	11	3	1	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	033	0	1	01	01	H1290_033_0	13	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	033	0	1	01	01	H1290_033_0	13	Generic	4	11	1	1	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	033	0	1	01	01	H1290_033_0	13	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	033	0	1	01	01	H1290_033_0	13	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	033	0	1	01	01	H1290_033_0	13	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												
H1290	034	0	1	01	01	H1290_034_0	13	Preferred Generic	4	11	3	1	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	034	0	1	01	01	H1290_034_0	13	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	034	0	1	01	01	H1290_034_0	13	Generic	4	11	1	1	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	034	0	1	01	01	H1290_034_0	13	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	034	0	1	01	01	H1290_034_0	13	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	034	0	1	01	01	H1290_034_0	13	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												
H1290	035	0	1	01	01	H1290_035_0	10	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	035	0	1	01	01	H1290_035_0	10	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	035	0	1	01	01	H1290_035_0	10	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	105.00																			35.00	70.00	87.50																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	035	0	1	01	01	H1290_035_0	10	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	035	0	1	01	01	H1290_035_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1047.86	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	036	1	1	01	01	H1290_036_1	11	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	036	1	1	01	01	H1290_036_1	11	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										2	2	
H1290	036	1	1	01	01	H1290_036_1	11	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	036	1	1	01	01	H1290_036_1	11	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										2	2	3
H1290	036	1	1	01	01	H1290_036_1	11	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																			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												
H1290	036	1	1	01	01	H1290_036_1	11	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												
H1290	036	1	1	01	01	H1290_036_1	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1291.92	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	036	2	1	01	01	H1290_036_2	11	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	036	2	1	01	01	H1290_036_2	11	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										2	2	
H1290	036	2	1	01	01	H1290_036_2	11	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	036	2	1	01	01	H1290_036_2	11	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										2	2	3
H1290	036	2	1	01	01	H1290_036_2	11	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																			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												
H1290	036	2	1	01	01	H1290_036_2	11	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												
H1290	036	2	1	01	01	H1290_036_2	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1291.92	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	1	1	01	01	H1290_037_1	10	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	037	1	1	01	01	H1290_037_1	10	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	037	1	1	01	01	H1290_037_1	10	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				93.87	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	1	1	01	01	H1290_037_1	10	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				138.33	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	1	1	01	01	H1290_037_1	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				768.42	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	2	1	01	01	H1290_037_2	11	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	037	2	1	01	01	H1290_037_2	11	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	037	2	1	01	01	H1290_037_2	11	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				93.87	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	2	1	01	01	H1290_037_2	11	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				138.33	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	2	1	01	01	H1290_037_2	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				768.42	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	3	1	01	01	H1290_037_3	11	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	037	3	1	01	01	H1290_037_3	11	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	037	3	1	01	01	H1290_037_3	11	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				93.87	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	3	1	01	01	H1290_037_3	11	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				138.33	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	3	1	01	01	H1290_037_3	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				768.42	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	038	1	1	01	01	H1290_038_1	9	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	038	1	1	01	01	H1290_038_1	9	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	038	1	1	01	01	H1290_038_1	9	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				77.39	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	038	1	1	01	01	H1290_038_1	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				138.08	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	038	1	1	01	01	H1290_038_1	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				790.54	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	038	2	1	01	01	H1290_038_2	9	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	038	2	1	01	01	H1290_038_2	9	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	038	2	1	01	01	H1290_038_2	9	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				77.39	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	038	2	1	01	01	H1290_038_2	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				138.08	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	038	2	1	01	01	H1290_038_2	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				790.54	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	7	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					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												
H1304	004	0	1	04	01	H1304_004_0	7	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					8.00	16.00	16.00					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												
H1304	004	0	1	04	01	H1304_004_0	7	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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1192.09	33						1192.09	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	1	1	04	01	H1304_011_1	8	Preferred Generic	4	01	3	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					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												
H1304	011	1	1	04	01	H1304_011_1	8	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	60.00					13.00	26.00	39.00					13.00	26.00	0.00																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	8	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					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												
H1304	011	1	1	04	01	H1304_011_1	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1047.59	29						1047.59	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	2	1	04	01	H1304_011_2	8	Preferred Generic	4	01	3	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					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												
H1304	011	2	1	04	01	H1304_011_2	8	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	60.00					13.00	26.00	39.00					13.00	26.00	0.00																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	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					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												
H1304	011	2	1	04	01	H1304_011_2	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1047.59	29						1047.59	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	1	1	04	01	H1304_012_1	7	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					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												
H1304	012	1	1	04	01	H1304_012_1	7	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	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1047.59	29						1047.59	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	2	1	04	01	H1304_012_2	7	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					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												
H1304	012	2	1	04	01	H1304_012_2	7	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	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1047.59	29						1047.59	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	1	1	01	01	H1350_015_1	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											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, Select Care Drugs												
H1350	015	1	1	01	01	H1350_015_1	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	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, Select Care Drugs												
H1350	015	1	1	01	01	H1350_015_1	3	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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, Select Care Drugs												
H1350	015	1	1	01	01	H1350_015_1	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											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, Select Care Drugs												
H1350	015	1	1	01	01	H1350_015_1	3	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, Select Care Drugs												
H1350	015	1	1	01	01	H1350_015_1	3	Select Care Drugs	4	01	1	2	6	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				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1350	015	2	1	01	01	H1350_015_2	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											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, Select Care Drugs												
H1350	015	2	1	01	01	H1350_015_2	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	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, Select Care Drugs												
H1350	015	2	1	01	01	H1350_015_2	3	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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, Select Care Drugs												
H1350	015	2	1	01	01	H1350_015_2	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											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, Select Care Drugs												
H1350	015	2	1	01	01	H1350_015_2	3	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, Select Care Drugs												
H1350	015	2	1	01	01	H1350_015_2	3	Select Care Drugs	4	01	1	2	6	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				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1350	016	1	1	01	01	H1350_016_1	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1350	016	1	1	01	01	H1350_016_1	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											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, Select Care Drugs												
H1350	016	1	1	01	01	H1350_016_1	3	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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, Select Care Drugs												
H1350	016	1	1	01	01	H1350_016_1	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											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, Select Care Drugs												
H1350	016	1	1	01	01	H1350_016_1	3	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, Select Care Drugs												
H1350	016	1	1	01	01	H1350_016_1	3	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	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, Select Care Drugs												
H1350	016	2	1	01	01	H1350_016_2	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1350	016	2	1	01	01	H1350_016_2	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											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, Select Care Drugs												
H1350	016	2	1	01	01	H1350_016_2	3	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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, Select Care Drugs												
H1350	016	2	1	01	01	H1350_016_2	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											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, Select Care Drugs												
H1350	016	2	1	01	01	H1350_016_2	3	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, Select Care Drugs												
H1350	016	2	1	01	01	H1350_016_2	3	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	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, Select Care Drugs												
H1350	019	1	1	01	01	H1350_019_1	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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, Select Care Drugs												
H1350	019	1	1	01	01	H1350_019_1	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											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, Select Care Drugs												
H1350	019	1	1	01	01	H1350_019_1	3	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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, Select Care Drugs												
H1350	019	1	1	01	01	H1350_019_1	3	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, Select Care Drugs												
H1350	019	1	1	01	01	H1350_019_1	3	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, Select Care Drugs												
H1350	019	1	1	01	01	H1350_019_1	3	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00	22.00	33.00				5.00	10.00	15.00				11.00				5.00			0.37	0.17		0.37	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	019	2	1	01	01	H1350_019_2	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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, Select Care Drugs												
H1350	019	2	1	01	01	H1350_019_2	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											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, Select Care Drugs												
H1350	019	2	1	01	01	H1350_019_2	3	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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, Select Care Drugs												
H1350	019	2	1	01	01	H1350_019_2	3	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, Select Care Drugs												
H1350	019	2	1	01	01	H1350_019_2	3	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, Select Care Drugs												
H1350	019	2	1	01	01	H1350_019_2	3	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00	22.00	33.00				5.00	10.00	15.00				11.00				5.00			0.37	0.17		0.37	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	023	1	1	01	01	H1350_023_1	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	023	1	1	01	01	H1350_023_1	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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, Select Care Drugs												
H1350	023	1	1	01	01	H1350_023_1	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	023	1	1	01	01	H1350_023_1	4	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, Select Care Drugs												
H1350	023	1	1	01	01	H1350_023_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	31						990.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	023	1	1	01	01	H1350_023_1	4	Select Care Drugs	4	01	1	2	6	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				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	023	2	1	01	01	H1350_023_2	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	023	2	1	01	01	H1350_023_2	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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, Select Care Drugs												
H1350	023	2	1	01	01	H1350_023_2	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	023	2	1	01	01	H1350_023_2	4	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, Select Care Drugs												
H1350	023	2	1	01	01	H1350_023_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	31						990.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	023	2	1	01	01	H1350_023_2	4	Select Care Drugs	4	01	1	2	6	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				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	024	1	1	01	01	H1350_024_1	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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, Select Care Drugs												
H1350	024	1	1	01	01	H1350_024_1	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	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, Select Care Drugs												
H1350	024	1	1	01	01	H1350_024_1	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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, Select Care Drugs												
H1350	024	1	1	01	01	H1350_024_1	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H1350	024	1	1	01	01	H1350_024_1	5	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, Select Care Drugs												
H1350	024	1	1	01	01	H1350_024_1	5	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								11.00	22.00	33.00					3.00	6.00	9.00											11.00	22.00	33.00				3.00	6.00	9.00				11.00				3.00			0.37	0.10		0.37	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	024	2	1	01	01	H1350_024_2	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H1350	024	2	1	01	01	H1350_024_2	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	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, Select Care Drugs												
H1350	024	2	1	01	01	H1350_024_2	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	024	2	1	01	01	H1350_024_2	4	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, Select Care Drugs												
H1350	024	2	1	01	01	H1350_024_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	29						990.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	024	2	1	01	01	H1350_024_2	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								11.00	22.00	33.00					3.00	6.00	9.00											11.00	22.00	33.00				3.00	6.00	9.00				11.00				3.00			0.37	0.10		0.37	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	024	3	1	01	01	H1350_024_3	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				3.00			0.50	0.10		0.50	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	024	3	1	01	01	H1350_024_3	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	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, Select Care Drugs												
H1350	024	3	1	01	01	H1350_024_3	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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, Select Care Drugs												
H1350	024	3	1	01	01	H1350_024_3	5	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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, Select Care Drugs												
H1350	024	3	1	01	01	H1350_024_3	5	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, Select Care Drugs												
H1350	024	3	1	01	01	H1350_024_3	5	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								11.00	22.00	33.00					3.00	6.00	9.00											11.00	22.00	33.00				3.00	6.00	9.00				11.00				3.00			0.37	0.10		0.37	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	026	0	1	01	01	H1350_026_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H1350	026	0	1	01	01	H1350_026_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	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, Select Care Drugs												
H1350	026	0	1	01	01	H1350_026_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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, Select Care Drugs												
H1350	026	0	1	01	01	H1350_026_0	4	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H1350	026	0	1	01	01	H1350_026_0	4	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 Brand, Specialty Tier, Select Care Drugs												
H1350	026	0	1	01	01	H1350_026_0	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								11.00	22.00	33.00					10.00	20.00	30.00											11.00	22.00	33.00				10.00	20.00	30.00				11.00				10.00			0.37	0.33		0.37	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	027	1	1	01	01	H1350_027_1	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				0.00			0.50	0.00		0.50	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	027	1	1	01	01	H1350_027_1	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				6.00			0.67	0.20		0.67	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	027	1	1	01	01	H1350_027_1	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	027	1	1	01	01	H1350_027_1	4	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, Select Care Drugs												
H1350	027	1	1	01	01	H1350_027_1	4	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, Select Care Drugs												
H1350	027	1	1	01	01	H1350_027_1	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	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				0.00			0.37	0.00		0.37	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	027	2	1	01	01	H1350_027_2	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				0.00			0.50	0.00		0.50	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	027	2	1	01	01	H1350_027_2	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				6.00			0.67	0.20		0.67	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	027	2	1	01	01	H1350_027_2	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	027	2	1	01	01	H1350_027_2	4	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, Select Care Drugs												
H1350	027	2	1	01	01	H1350_027_2	4	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, Select Care Drugs												
H1350	027	2	1	01	01	H1350_027_2	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	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				0.00			0.37	0.00		0.37	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1352	003	0	1	01	01	H1352_003_0	10	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	003	0	1	01	01	H1352_003_0	10	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1352	003	0	1	01	01	H1352_003_0	10	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				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	10	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				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	10	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				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	10	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	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	10	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	004	0	1	01	01	H1352_004_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	004	0	1	01	01	H1352_004_0	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1352	004	0	1	01	01	H1352_004_0	9	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				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	004	0	1	01	01	H1352_004_0	9	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				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	004	0	1	01	01	H1352_004_0	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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	004	0	1	01	01	H1352_004_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	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	004	0	1	01	01	H1352_004_0	9	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	002	0	1	01	01	H1353_002_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	002	0	1	01	01	H1353_002_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	8.00	16.00	24.00																									8.00	16.00	24.00				8.00	16.00	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	002	0	1	01	01	H1353_002_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	120.00																									40.00	80.00	120.00				40.00	80.00	80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	002	0	1	01	01	H1353_002_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.12	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	002	0	1	01	01	H1353_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	002	0	1	01	01	H1353_002_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	004	0	1	01	01	H1353_004_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	004	0	1	01	01	H1353_004_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	12.00	24.00	36.00																									12.00	24.00	36.00				12.00	24.00	0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	004	0	1	01	01	H1353_004_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	004	0	1	01	01	H1353_004_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.71	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	004	0	1	01	01	H1353_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	004	0	1	01	01	H1353_004_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	005	0	1	01	01	H1353_005_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	005	0	1	01	01	H1353_005_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	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, Select Care Drugs												
H1353	005	0	1	01	01	H1353_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H1353	005	0	1	01	01	H1353_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1353	005	0	1	01	01	H1353_005_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	005	0	1	01	01	H1353_005_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	006	0	1	01	01	H1353_006_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	006	0	1	01	01	H1353_006_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	006	0	1	01	01	H1353_006_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H1353	006	0	1	01	01	H1353_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1353	006	0	1	01	01	H1353_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	006	0	1	01	01	H1353_006_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	007	0	1	01	01	H1353_007_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	007	0	1	01	01	H1353_007_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	007	0	1	01	01	H1353_007_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	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, Select Care Drugs												
H1353	007	0	1	01	01	H1353_007_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.09	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	007	0	1	01	01	H1353_007_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1353	007	0	1	01	01	H1353_007_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1365	001	0	1	04	01	H1365_001_0	6	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	6	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	6	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	1	1	04	01	H1365_004_1	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	1	1	04	01	H1365_004_1	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	1	1	04	01	H1365_004_1	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	1	1	04	01	H1365_004_1	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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	004	1	1	04	01	H1365_004_1	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	2	1	04	01	H1365_004_2	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	2	1	04	01	H1365_004_2	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	2	1	04	01	H1365_004_2	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	2	1	04	01	H1365_004_2	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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	004	2	1	04	01	H1365_004_2	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1372	002	0	1	01	01	H1372_002_0	7	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												
H1372	002	0	1	01	01	H1372_002_0	7	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																					45.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	002	0	1	01	01	H1372_002_0	7	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	2			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	002	0	1	01	01	H1372_002_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	002	0	1	01	01	H1372_002_0	7	Specialty Tier	4	01	1	1	5	1	111		01	100		1	30	60	90				2	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	003	0	1	01	01	H1372_003_0	7	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												
H1372	003	0	1	01	01	H1372_003_0	7	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																					45.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	003	0	1	01	01	H1372_003_0	7	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	2			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	003	0	1	01	01	H1372_003_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	003	0	1	01	01	H1372_003_0	7	Specialty Tier	4	01	1	1	5	1	111		01	100		1	30	60	90				2	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1395	001	0	1	04	01	H1395_001_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	001	0	1	04	01	H1395_001_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	9.00	18.00	27.00																									9.00	18.00	27.00				9.00	18.00	0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	001	0	1	04	01	H1395_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	120.00																									40.00	80.00	120.00				40.00	80.00	80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	001	0	1	04	01	H1395_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.70	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	001	0	1	04	01	H1395_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	001	0	1	04	01	H1395_001_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	002	0	1	04	01	H1395_002_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	002	0	1	04	01	H1395_002_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H1395	002	0	1	04	01	H1395_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1395	002	0	1	04	01	H1395_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.83	45	45	45				94.44	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	002	0	1	04	01	H1395_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	002	0	1	04	01	H1395_002_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	003	0	1	04	01	H1395_003_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	003	0	1	04	01	H1395_003_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	003	0	1	04	01	H1395_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	003	0	1	04	01	H1395_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.10	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	003	0	1	04	01	H1395_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	003	0	1	04	01	H1395_003_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1415	021	0	1	02	01	H1415_021_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3	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	0.00				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	3	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	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.35	50	50	50				64.89	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											876.64	33						904.81	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	024	0	1	01	01	H1415_024_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	3	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	0.00				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	3	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	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											92.28	50	50	50				76.53	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	024	0	1	01	01	H1415_024_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											742.01	33						750.22	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	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	009	0	1	02	01	H1416_009_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	009	0	1	02	01	H1416_009_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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												
H1416	009	0	1	02	01	H1416_009_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.73	41	41	41				93.92	39	39	39										41	41	41				39	39	39			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	009	0	1	02	01	H1416_009_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	009	0	1	02	01	H1416_009_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	023	0	1	01	01	H1416_023_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	023	0	1	01	01	H1416_023_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	023	0	1	01	01	H1416_023_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H1416	023	0	1	01	01	H1416_023_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.06	45	45	45																								45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	023	0	1	01	01	H1416_023_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	023	0	1	01	01	H1416_023_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	026	0	1	02	01	H1416_026_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	026	0	1	02	01	H1416_026_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1416	026	0	1	02	01	H1416_026_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					30.00	60.00	90.00											40.00	80.00	120.00				30.00	60.00	60.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	026	0	1	02	01	H1416_026_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	297.00					89.00	178.00	267.00											99.00	198.00	297.00				89.00	178.00	178.00				99.00				99.00			3.3	2.97		3.3	2.97	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	026	0	1	02	01	H1416_026_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	026	0	1	02	01	H1416_026_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	033	0	1	02	01	H1416_033_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	033	0	1	02	01	H1416_033_0	5	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	15.00				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												
H1416	033	0	1	02	01	H1416_033_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	30.00	60.00	90.00																									30.00	60.00	90.00				30.00	60.00	60.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	033	0	1	02	01	H1416_033_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				85.03	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	033	0	1	02	01	H1416_033_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	033	0	1	02	01	H1416_033_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	034	0	1	01	01	H1416_034_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	034	0	1	01	01	H1416_034_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	034	0	1	01	01	H1416_034_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	034	0	1	01	01	H1416_034_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.50	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	034	0	1	01	01	H1416_034_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	034	0	1	01	01	H1416_034_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	035	0	1	01	01	H1416_035_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	035	0	1	01	01	H1416_035_0	5	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	15.00				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												
H1416	035	0	1	01	01	H1416_035_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	30.00	60.00	90.00																									30.00	60.00	90.00				30.00	60.00	60.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	035	0	1	01	01	H1416_035_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				93.09	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	035	0	1	01	01	H1416_035_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	035	0	1	01	01	H1416_035_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	036	0	1	01	01	H1416_036_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	036	0	1	01	01	H1416_036_0	4	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	15.00				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												
H1416	036	0	1	01	01	H1416_036_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	34.00	68.00	102.00																									34.00	68.00	102.00				34.00	68.00	68.00				34.00				34.00		1.13				1.13	1.13	1.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	036	0	1	01	01	H1416_036_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				95.95	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	036	0	1	01	01	H1416_036_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	036	0	1	01	01	H1416_036_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	041	0	1	01	01	H1416_041_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	041	0	1	01	01	H1416_041_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	11.00	22.00	33.00																									11.00	22.00	33.00				11.00	22.00	0.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	041	0	1	01	01	H1416_041_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	041	0	1	01	01	H1416_041_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				89.30	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	041	0	1	01	01	H1416_041_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	041	0	1	01	01	H1416_041_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	042	0	1	01	01	H1416_042_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	042	0	1	01	01	H1416_042_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	042	0	1	01	01	H1416_042_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	042	0	1	01	01	H1416_042_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.35	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	042	0	1	01	01	H1416_042_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	042	0	1	01	01	H1416_042_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	043	0	1	02	01	H1416_043_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	043	0	1	02	01	H1416_043_0	5	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	15.00				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												
H1416	043	0	1	02	01	H1416_043_0	5	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																									36.00	72.00	108.00				36.00	72.00	72.00				36.00				36.00		1.2				1.2	1.2	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	043	0	1	02	01	H1416_043_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				88.20	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	043	0	1	02	01	H1416_043_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	043	0	1	02	01	H1416_043_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	044	0	1	01	01	H1416_044_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	044	0	1	01	01	H1416_044_0	5	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	15.00				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												
H1416	044	0	1	01	01	H1416_044_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	044	0	1	01	01	H1416_044_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.80	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	044	0	1	01	01	H1416_044_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	044	0	1	01	01	H1416_044_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	048	0	1	01	01	H1416_048_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	048	0	1	01	01	H1416_048_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	048	0	1	01	01	H1416_048_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	43.00	86.00	129.00																									43.00	86.00	129.00				43.00	86.00	86.00				43.00				43.00		1.43				1.43	1.43	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	048	0	1	01	01	H1416_048_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.41	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	048	0	1	01	01	H1416_048_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	048	0	1	01	01	H1416_048_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	055	0	1	01	01	H1416_055_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	055	0	1	01	01	H1416_055_0	5	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	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	055	0	1	01	01	H1416_055_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	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, Select Care Drugs												
H1416	055	0	1	01	01	H1416_055_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	99.00	198.00	297.00																									99.00	198.00	297.00				99.00	198.00	198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	055	0	1	01	01	H1416_055_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	055	0	1	01	01	H1416_055_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	056	0	1	01	01	H1416_056_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	056	0	1	01	01	H1416_056_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	056	0	1	01	01	H1416_056_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H1416	056	0	1	01	01	H1416_056_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.83	47	47	47				94.63	45	45	45										47	47	47				45	45	45			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	056	0	1	01	01	H1416_056_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	056	0	1	01	01	H1416_056_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	057	0	1	01	01	H1416_057_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	057	0	1	01	01	H1416_057_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	057	0	1	01	01	H1416_057_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H1416	057	0	1	01	01	H1416_057_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1416	057	0	1	01	01	H1416_057_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	057	0	1	01	01	H1416_057_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	064	0	1	01	01	H1416_064_0	5	Preferred Generic	4	11	3	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	2.00	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												
H1416	064	0	1	01	01	H1416_064_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	064	0	1	01	01	H1416_064_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	120.00																									40.00	80.00	120.00				40.00	80.00	80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	064	0	1	01	01	H1416_064_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	99.00	198.00	297.00																									99.00	198.00	297.00				99.00	198.00	198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	064	0	1	01	01	H1416_064_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	064	0	1	01	01	H1416_064_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	065	0	1	01	01	H1416_065_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	065	0	1	01	01	H1416_065_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1416	065	0	1	01	01	H1416_065_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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												
H1416	065	0	1	01	01	H1416_065_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	297.00					89.00	178.00	267.00											99.00	198.00	297.00				89.00	178.00	178.00				99.00				99.00			3.3	2.97		3.3	2.97	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	065	0	1	01	01	H1416_065_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	065	0	1	01	01	H1416_065_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	066	0	1	01	01	H1416_066_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1416	066	0	1	01	01	H1416_066_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2	2	3
H1416	066	0	1	01	01	H1416_066_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H1416	066	0	1	01	01	H1416_066_0	4	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		
H1416	066	0	1	01	01	H1416_066_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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 Diabetic Drugs												
H1416	066	0	1	01	01	H1416_066_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Diabetic Drugs												
H1416	066	0	1	01	01	H1416_066_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1416	066	0	1	01	01	H1416_066_0	4	Select Diabetic Drugs	4	10	1	2	6	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	22.00	33.00				11.00	22.00	22.00				11.00				11.00			0.37	0.37		0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1416	066	0	1	01	01	H1416_066_0	4	Select Diabetic Drugs	4	10	1	2	6	3		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	22.00	33.00				11.00	22.00	22.00				11.00				11.00			0.37	0.37		0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2		
H1416	068	0	1	01	01	H1416_068_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	068	0	1	01	01	H1416_068_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	068	0	1	01	01	H1416_068_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	068	0	1	01	01	H1416_068_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.16	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	068	0	1	01	01	H1416_068_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	068	0	1	01	01	H1416_068_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	070	0	1	01	01	H1416_070_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	070	0	1	01	01	H1416_070_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1416	070	0	1	01	01	H1416_070_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	070	0	1	01	01	H1416_070_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H1416	070	0	1	01	01	H1416_070_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.88	42	42	42				94.17	40	40	40										42	42	42				40	40	40			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	070	0	1	01	01	H1416_070_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	070	0	1	01	01	H1416_070_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	070	0	1	01	01	H1416_070_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1416	071	0	1	01	01	H1416_071_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	071	0	1	01	01	H1416_071_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1416	071	0	1	01	01	H1416_071_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	071	0	1	01	01	H1416_071_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H1416	071	0	1	01	01	H1416_071_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.30	47	47	47				95.07	45	45	45										47	47	47				45	45	45			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	071	0	1	01	01	H1416_071_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	071	0	1	01	01	H1416_071_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	071	0	1	01	01	H1416_071_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1416	072	0	1	01	01	H1416_072_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	072	0	1	01	01	H1416_072_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1416	072	0	1	01	01	H1416_072_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	072	0	1	01	01	H1416_072_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H1416	072	0	1	01	01	H1416_072_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.81	46	46	46				94.52	44	44	44										46	46	46				44	44	44			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	072	0	1	01	01	H1416_072_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	072	0	1	01	01	H1416_072_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	072	0	1	01	01	H1416_072_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1416	073	1	1	01	01	H1416_073_1	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	073	1	1	01	01	H1416_073_1	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H1416	073	1	1	01	01	H1416_073_1	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H1416	073	1	1	01	01	H1416_073_1	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.51	45	45	45				95.09	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	073	1	1	01	01	H1416_073_1	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	073	1	1	01	01	H1416_073_1	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	073	2	1	01	01	H1416_073_2	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	073	2	1	01	01	H1416_073_2	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H1416	073	2	1	01	01	H1416_073_2	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1416	073	2	1	01	01	H1416_073_2	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.51	45	45	45				95.09	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	073	2	1	01	01	H1416_073_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	073	2	1	01	01	H1416_073_2	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	073	3	1	01	01	H1416_073_3	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	073	3	1	01	01	H1416_073_3	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H1416	073	3	1	01	01	H1416_073_3	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H1416	073	3	1	01	01	H1416_073_3	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.51	45	45	45				95.09	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	073	3	1	01	01	H1416_073_3	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	073	3	1	01	01	H1416_073_3	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	075	0	1	02	01	H1416_075_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	075	0	1	02	01	H1416_075_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1416	075	0	1	02	01	H1416_075_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H1416	075	0	1	02	01	H1416_075_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.82	43	43	43				93.27	41	41	41										43	43	43				41	41	41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	075	0	1	02	01	H1416_075_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	075	0	1	02	01	H1416_075_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	076	0	1	02	01	H1416_076_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	076	0	1	02	01	H1416_076_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1416	076	0	1	02	01	H1416_076_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H1416	076	0	1	02	01	H1416_076_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.07	44	44	44				93.61	42	42	42										44	44	44				42	42	42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	076	0	1	02	01	H1416_076_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	076	0	1	02	01	H1416_076_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	077	0	1	02	01	H1416_077_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	077	0	1	02	01	H1416_077_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1416	077	0	1	02	01	H1416_077_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H1416	077	0	1	02	01	H1416_077_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.75	45	45	45				94.36	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	077	0	1	02	01	H1416_077_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	077	0	1	02	01	H1416_077_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	7	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	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	001	0	1	01	01	H1423_001_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	7	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	7	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	6	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	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	002	0	1	01	01	H1423_002_0	6	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	6	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1423	002	0	1	01	01	H1423_002_0	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	6	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	6	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	6	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	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	003	0	1	01	01	H1423_003_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	6	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	6	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	6	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	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	004	0	1	01	01	H1423_004_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	6	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	6	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H1423	005	0	1	01	01	H1423_005_0	6	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					0.00	0.00	0.00																15.50				15.50			0.52	0.35	0.00			0.46	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	005	0	1	01	01	H1423_005_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	005	0	1	01	01	H1423_005_0	6	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												
H1423	007	0	1	01	01	H1423_007_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																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	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	007	0	1	01	01	H1423_007_0	7	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	007	0	1	01	01	H1423_007_0	7	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	7	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	7	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	7	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	7	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	7	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	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	008	0	1	01	01	H1423_008_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	008	0	1	01	01	H1423_008_0	7	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	008	0	1	01	01	H1423_008_0	7	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	7	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	7	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	7	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	7	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	7	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	009	0	1	01	01	H1423_009_0	8	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												
H1423	009	0	1	01	01	H1423_009_0	8	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		
H1423	009	0	1	01	01	H1423_009_0	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1423	009	0	1	01	01	H1423_009_0	8	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												
H1423	009	0	1	01	01	H1423_009_0	8	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												
H1423	009	0	1	01	01	H1423_009_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	3	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1426	001	0	1	01	01	H1426_001_0	3	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	3	Generic	4	01	3	2	2	3	110		01	100		1	30		90				2	2			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1426	001	0	1	01	01	H1426_001_0	3	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	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												
H1426	001	0	1	01	01	H1426_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		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	3	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				361.89	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	3	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1426	002	0	1	01	01	H1426_002_0	3	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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				326.31	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	3	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	3	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				13.04	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	3	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				123.88	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				57.67	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	3	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				289.94	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1436	002	0	1	01	01	H1436_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	002	0	1	01	01	H1436_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H1436	002	0	1	01	01	H1436_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1436	002	0	1	01	01	H1436_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1436	002	0	1	01	01	H1436_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	002	0	1	01	01	H1436_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1436	004	0	1	01	01	H1436_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	005	0	1	01	01	H1436_005_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	005	0	1	01	01	H1436_005_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	005	0	1	01	01	H1436_005_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				93.15	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	005	0	1	01	01	H1436_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	005	0	1	01	01	H1436_005_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	007	0	1	01	01	H1436_007_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	007	0	1	01	01	H1436_007_0	4	Generic	4	11	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	12.00	0.00				6.00				6.00		0.2				0.2	0.2	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	007	0	1	01	01	H1436_007_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	007	0	1	01	01	H1436_007_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.22	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	007	0	1	01	01	H1436_007_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	007	0	1	01	01	H1436_007_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1463	003	0	1	01	01	H1463_003_0	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	003	0	1	01	01	H1463_003_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				71.09	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	009	0	1	01	01	H1463_009_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				83.78	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	010	0	1	01	01	H1463_010_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	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	8	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	8	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				71.95	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	8	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	013	0	1	01	01	H1463_013_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	013	0	1	01	01	H1463_013_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				70.20	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	015	0	1	02	01	H1463_015_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.74	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	017	0	1	02	01	H1463_017_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				79.43	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	019	0	1	02	01	H1463_019_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				66.43	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	021	0	1	01	01	H1463_021_0	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	021	0	1	01	01	H1463_021_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				87.99	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	022	0	1	02	01	H1463_022_0	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	022	0	1	02	01	H1463_022_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				64.69	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	023	0	1	01	01	H1463_023_0	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	023	0	1	01	01	H1463_023_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.37	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	024	0	1	01	01	H1463_024_0	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	024	0	1	01	01	H1463_024_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				80.25	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	025	0	1	02	01	H1463_025_0	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	025	0	1	02	01	H1463_025_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				80.04	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	032	0	1	01	01	H1463_032_0	12	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	12	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	032	0	1	01	01	H1463_032_0	12	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	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	12	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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	12	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				81.08	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	032	0	1	01	01	H1463_032_0	12	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					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	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	033	0	1	01	01	H1463_033_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				79.49	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	034	0	1	02	01	H1463_034_0	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	034	0	1	02	01	H1463_034_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				78.09	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	035	0	1	01	01	H1463_035_0	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	035	0	1	01	01	H1463_035_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				86.95	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	036	0	1	02	01	H1463_036_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	036	0	1	02	01	H1463_036_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				73.35	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	039	0	1	01	01	H1463_039_0	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	039	0	1	01	01	H1463_039_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				84.04	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	040	0	1	02	01	H1463_040_0	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	040	0	1	02	01	H1463_040_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				95.81	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	9	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	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	041	0	1	01	01	H1463_041_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				95.88	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	9	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	042	0	1	02	01	H1463_042_0	11	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	042	0	1	02	01	H1463_042_0	11	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1463	042	0	1	02	01	H1463_042_0	11	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	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	042	0	1	02	01	H1463_042_0	11	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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	042	0	1	02	01	H1463_042_0	11	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				89.99	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	042	0	1	02	01	H1463_042_0	11	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												
H1468	007	0	1	01	01	H1468_007_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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												
H1468	007	0	1	01	01	H1468_007_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	017	0	1	01	01	H1468_017_0	7	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												
H1468	017	0	1	01	01	H1468_017_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	7	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	018	0	1	01	01	H1468_018_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	018	0	1	01	01	H1468_018_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	018	0	1	01	01	H1468_018_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	019	0	1	01	01	H1468_019_0	8	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					3.00		9.00											5.00		15.00				3.00		0.00				5.00				5.00			0.17	0.10		0.17	0.10	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	019	0	1	01	01	H1468_019_0	8	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					10.00		30.00											10.00		30.00				10.00		0.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	019	0	1	01	01	H1468_019_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												
H1468	019	0	1	01	01	H1468_019_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												
H1468	019	0	1	01	01	H1468_019_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												
H1468	020	0	1	01	01	H1468_020_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	020	0	1	01	01	H1468_020_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	020	0	1	01	01	H1468_020_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	020	0	1	01	01	H1468_020_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	020	0	1	01	01	H1468_020_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1607	012	0	1	04	01	H1607_012_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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	012	0	1	04	01	H1607_012_0	7	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	7	Preferred Brand	4	11	1	2	3	1		111	01	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	7	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	7	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	8	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	8	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					0.00	0.00	0.00																18.00				18.00			0.60	0.43	0.00			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	015	0	1	04	01	H1607_015_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	015	0	1	04	01	H1607_015_0	8	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	8	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	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H1608	001	0	1	04	01	H1608_001_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											867.55	33						579.93	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H1608	004	0	1	04	01	H1608_004_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											828.24	33						444.91	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H1608	008	0	1	04	01	H1608_008_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											996.36	33						468.42	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H1608	012	0	1	04	01	H1608_012_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											846.73	33						275.77	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1048.29	30						301.31	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	016	0	1	04	01	H1608_016_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	016	0	1	04	01	H1608_016_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	016	0	1	04	01	H1608_016_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	016	0	1	04	01	H1608_016_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	016	0	1	04	01	H1608_016_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											883.23	33						479.49	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	017	0	1	04	01	H1608_017_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	017	0	1	04	01	H1608_017_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											895.49	33						663.52	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	018	0	1	04	01	H1608_018_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	018	0	1	04	01	H1608_018_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	018	0	1	04	01	H1608_018_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	018	0	1	04	01	H1608_018_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	018	0	1	04	01	H1608_018_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1038.23	33						719.45	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	021	0	1	04	01	H1608_021_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	021	0	1	04	01	H1608_021_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	021	0	1	04	01	H1608_021_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	021	0	1	04	01	H1608_021_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	021	0	1	04	01	H1608_021_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1070.14	33						699.50	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	024	0	1	04	01	H1608_024_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	024	0	1	04	01	H1608_024_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	024	0	1	04	01	H1608_024_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	024	0	1	04	01	H1608_024_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	024	0	1	04	01	H1608_024_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											911.71	33						510.59	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1122.84	33						551.87	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											856.78	33						869.28	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	028	0	1	04	01	H1608_028_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1169.85	29						687.43	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	029	0	1	04	01	H1608_029_0	3	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					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												
H1608	029	0	1	04	01	H1608_029_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	029	0	1	04	01	H1608_029_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1158.29	33						531.76	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	031	0	1	04	01	H1608_031_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	031	0	1	04	01	H1608_031_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	031	0	1	04	01	H1608_031_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	031	0	1	04	01	H1608_031_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	031	0	1	04	01	H1608_031_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	031	0	1	04	01	H1608_031_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											829.95	29						393.88	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	035	0	1	04	01	H1608_035_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	035	0	1	04	01	H1608_035_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	035	0	1	04	01	H1608_035_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	035	0	1	04	01	H1608_035_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	035	0	1	04	01	H1608_035_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	035	0	1	04	01	H1608_035_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											935.57	30						475.05	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	037	0	1	04	01	H1608_037_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	037	0	1	04	01	H1608_037_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	037	0	1	04	01	H1608_037_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	037	0	1	04	01	H1608_037_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	037	0	1	04	01	H1608_037_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	037	0	1	04	01	H1608_037_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											966.41	33						642.72	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	038	0	1	04	01	H1608_038_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	038	0	1	04	01	H1608_038_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	038	0	1	04	01	H1608_038_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	038	0	1	04	01	H1608_038_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	038	0	1	04	01	H1608_038_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	038	0	1	04	01	H1608_038_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											786.20	33						527.91	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	039	0	1	04	01	H1608_039_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	039	0	1	04	01	H1608_039_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	039	0	1	04	01	H1608_039_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	039	0	1	04	01	H1608_039_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	039	0	1	04	01	H1608_039_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											927.27	33						555.89	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	040	0	1	04	01	H1608_040_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	040	0	1	04	01	H1608_040_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	040	0	1	04	01	H1608_040_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	040	0	1	04	01	H1608_040_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	040	0	1	04	01	H1608_040_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	040	0	1	04	01	H1608_040_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1058.30	33						512.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	041	0	1	04	01	H1608_041_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	041	0	1	04	01	H1608_041_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	041	0	1	04	01	H1608_041_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	041	0	1	04	01	H1608_041_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	041	0	1	04	01	H1608_041_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	041	0	1	04	01	H1608_041_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1041.73	33						564.54	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	043	0	1	04	01	H1608_043_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	043	0	1	04	01	H1608_043_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	043	0	1	04	01	H1608_043_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	043	0	1	04	01	H1608_043_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	043	0	1	04	01	H1608_043_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	043	0	1	04	01	H1608_043_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											768.78	33						439.41	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	047	0	1	04	01	H1608_047_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	047	0	1	04	01	H1608_047_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	047	0	1	04	01	H1608_047_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	047	0	1	04	01	H1608_047_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	047	0	1	04	01	H1608_047_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											929.08	33						487.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	048	0	1	04	01	H1608_048_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	048	0	1	04	01	H1608_048_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	048	0	1	04	01	H1608_048_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	048	0	1	04	01	H1608_048_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	048	0	1	04	01	H1608_048_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	048	0	1	04	01	H1608_048_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	048	0	1	04	01	H1608_048_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											958.77	33						324.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	050	0	1	04	01	H1608_050_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	050	0	1	04	01	H1608_050_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	050	0	1	04	01	H1608_050_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	050	0	1	04	01	H1608_050_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	050	0	1	04	01	H1608_050_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											938.00	33						714.47	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	051	0	1	04	01	H1608_051_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	051	0	1	04	01	H1608_051_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	051	0	1	04	01	H1608_051_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	051	0	1	04	01	H1608_051_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	051	0	1	04	01	H1608_051_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	051	0	1	04	01	H1608_051_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											852.15	30						407.91	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	052	0	1	04	01	H1608_052_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	052	0	1	04	01	H1608_052_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	052	0	1	04	01	H1608_052_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	052	0	1	04	01	H1608_052_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	052	0	1	04	01	H1608_052_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											833.16	33						428.31	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	053	0	1	04	01	H1608_053_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	053	0	1	04	01	H1608_053_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	053	0	1	04	01	H1608_053_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	053	0	1	04	01	H1608_053_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	053	0	1	04	01	H1608_053_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											854.63	33						302.32	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	054	0	1	04	01	H1608_054_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	054	0	1	04	01	H1608_054_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	054	0	1	04	01	H1608_054_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	054	0	1	04	01	H1608_054_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	054	0	1	04	01	H1608_054_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											916.03	33						382.45	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	056	0	1	04	01	H1608_056_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	056	0	1	04	01	H1608_056_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	056	0	1	04	01	H1608_056_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	056	0	1	04	01	H1608_056_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	056	0	1	04	01	H1608_056_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	056	0	1	04	01	H1608_056_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											955.24	30						610.00	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	059	0	1	04	01	H1608_059_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	059	0	1	04	01	H1608_059_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1608	059	0	1	04	01	H1608_059_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	059	0	1	04	01	H1608_059_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	059	0	1	04	01	H1608_059_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											930.76	33						460.83	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	001	0	1	02	01	H1609_001_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	001	0	1	02	01	H1609_001_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H1609_001_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	001	0	1	02	01	H1609_001_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H1609_001_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	001	0	1	02	01	H1609_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	001	0	1	02	01	H1609_001_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											917.72	33						459.84	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	009	0	1	02	01	H1609_009_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	009	0	1	02	01	H1609_009_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H1609_009_0	2	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					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												
H1609	009	0	1	02	01	H1609_009_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H1609_009_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	009	0	1	02	01	H1609_009_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	009	0	1	02	01	H1609_009_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											980.74	33						445.96	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	016	0	1	01	01	H1609_016_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	016	0	1	01	01	H1609_016_0	4	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	016	0	1	01	01	H1609_016_0	4	Generic	4	11	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					0.00	0.00	0.00											47.00	94.00	141.00				0.00	0.00	0.00					47.00			47.00			1.57	0.00		1.57	0.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	016	0	1	01	01	H1609_016_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					35.00	70.00	105.00											100.00	200.00	300.00				35.00	70.00	105.00					100.00			100.00			3.33	1.17		3.33	1.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	016	0	1	01	01	H1609_016_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1180.24	33						861.82	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	017	0	1	01	01	H1609_017_0	5	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	017	0	1	01	01	H1609_017_0	5	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	017	0	1	01	01	H1609_017_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	017	0	1	01	01	H1609_017_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											80.30	40	40	40				68.87	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	017	0	1	01	01	H1609_017_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											603.10	25						480.90	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	018	0	1	01	01	H1609_018_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	018	0	1	01	01	H1609_018_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	018	0	1	01	01	H1609_018_0	3	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	018	0	1	01	01	H1609_018_0	3	Generic	4	11	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	018	0	1	01	01	H1609_018_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					3.00	6.00	9.00											47.00	94.00	141.00				3.00	6.00	9.00					47.00			47.00			1.57	0.10		1.57	0.10	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	018	0	1	01	01	H1609_018_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					85.00	170.00	255.00											100.00	200.00	300.00				85.00	170.00	255.00					100.00			100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	018	0	1	01	01	H1609_018_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1068.92	33						562.65	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	019	0	1	01	01	H1609_019_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	019	0	1	01	01	H1609_019_0	4	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	019	0	1	01	01	H1609_019_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	019	0	1	01	01	H1609_019_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											83.49	40	40	40				74.37	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	019	0	1	01	01	H1609_019_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											696.58	25						484.21	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	020	0	1	01	01	H1609_020_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	020	0	1	01	01	H1609_020_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	020	0	1	01	01	H1609_020_0	3	Generic	4	11	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H1609	020	0	1	01	01	H1609_020_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H1609	020	0	1	01	01	H1609_020_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											991.26	33						688.52	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	021	0	1	01	01	H1609_021_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	021	0	1	01	01	H1609_021_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	021	0	1	01	01	H1609_021_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H1609	021	0	1	01	01	H1609_021_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H1609	021	0	1	01	01	H1609_021_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1008.57	33						689.47	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	022	0	1	01	01	H1609_022_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	022	0	1	01	01	H1609_022_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	022	0	1	01	01	H1609_022_0	3	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	022	0	1	01	01	H1609_022_0	3	Generic	4	11	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	022	0	1	01	01	H1609_022_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	022	0	1	01	01	H1609_022_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	022	0	1	01	01	H1609_022_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											939.15	33						640.96	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	023	0	1	01	01	H1609_023_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	023	0	1	01	01	H1609_023_0	4	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	023	0	1	01	01	H1609_023_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	023	0	1	01	01	H1609_023_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											76.56	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												
H1609	023	0	1	01	01	H1609_023_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											707.33	25						493.06	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	025	0	1	01	01	H1609_025_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	025	0	1	01	01	H1609_025_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	025	0	1	01	01	H1609_025_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H1609	025	0	1	01	01	H1609_025_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H1609	025	0	1	01	01	H1609_025_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1098.62	33						762.66	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	026	0	1	01	01	H1609_026_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	026	0	1	01	01	H1609_026_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	026	0	1	01	01	H1609_026_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H1609	026	0	1	01	01	H1609_026_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H1609	026	0	1	01	01	H1609_026_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1169.41	33						727.31	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	027	0	1	01	01	H1609_027_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	027	0	1	01	01	H1609_027_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	027	0	1	01	01	H1609_027_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H1609	027	0	1	01	01	H1609_027_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H1609	027	0	1	01	01	H1609_027_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											977.19	33						716.18	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	028	0	1	02	01	H1609_028_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	028	0	1	02	01	H1609_028_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	028	0	1	02	01	H1609_028_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	028	0	1	02	01	H1609_028_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	028	0	1	02	01	H1609_028_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											876.85	29						601.03	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	034	0	1	01	01	H1609_034_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	034	0	1	01	01	H1609_034_0	4	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	034	0	1	01	01	H1609_034_0	4	Generic	4	11	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	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												
H1609	034	0	1	01	01	H1609_034_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H1609	034	0	1	01	01	H1609_034_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1087.96	33						794.31	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	035	0	1	01	01	H1609_035_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	035	0	1	01	01	H1609_035_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	035	0	1	01	01	H1609_035_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H1609	035	0	1	01	01	H1609_035_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H1609	035	0	1	01	01	H1609_035_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1040.40	33						738.97	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	037	0	1	01	01	H1609_037_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	037	0	1	01	01	H1609_037_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	037	0	1	01	01	H1609_037_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H1609	037	0	1	01	01	H1609_037_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H1609	037	0	1	01	01	H1609_037_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1119.33	33						743.98	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	038	0	1	01	01	H1609_038_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	038	0	1	01	01	H1609_038_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	038	0	1	01	01	H1609_038_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H1609	038	0	1	01	01	H1609_038_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H1609	038	0	1	01	01	H1609_038_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1044.12	33						740.42	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	039	0	1	01	01	H1609_039_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	039	0	1	01	01	H1609_039_0	4	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	039	0	1	01	01	H1609_039_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	039	0	1	01	01	H1609_039_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											74.31	35	35	35				65.51	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	039	0	1	01	01	H1609_039_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											612.14	25						484.32	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	040	0	1	01	01	H1609_040_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	040	0	1	01	01	H1609_040_0	4	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	040	0	1	01	01	H1609_040_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	040	0	1	01	01	H1609_040_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											80.67	40	40	40				71.62	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	040	0	1	01	01	H1609_040_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											632.10	25						522.04	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	041	0	1	01	01	H1609_041_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	041	0	1	01	01	H1609_041_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	041	0	1	01	01	H1609_041_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H1609	041	0	1	01	01	H1609_041_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H1609	041	0	1	01	01	H1609_041_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1116.23	33						784.79	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	042	0	1	01	01	H1609_042_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	042	0	1	01	01	H1609_042_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	042	0	1	01	01	H1609_042_0	3	Generic	4	11	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H1609	042	0	1	01	01	H1609_042_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H1609	042	0	1	01	01	H1609_042_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											919.81	33						655.31	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	043	0	1	01	01	H1609_043_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	043	0	1	01	01	H1609_043_0	4	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	043	0	1	01	01	H1609_043_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	043	0	1	01	01	H1609_043_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											75.07	40	40	40				68.12	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	043	0	1	01	01	H1609_043_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											612.07	25						436.60	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	044	0	1	01	01	H1609_044_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	044	0	1	01	01	H1609_044_0	4	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	044	0	1	01	01	H1609_044_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	044	0	1	01	01	H1609_044_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											78.15	40	40	40				72.38	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	044	0	1	01	01	H1609_044_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											594.78	25						419.33	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	045	0	1	01	01	H1609_045_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	045	0	1	01	01	H1609_045_0	4	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	045	0	1	01	01	H1609_045_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	045	0	1	01	01	H1609_045_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											72.47	35	35	35				63.55	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	045	0	1	01	01	H1609_045_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											640.61	25						520.99	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	046	0	1	01	01	H1609_046_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	046	0	1	01	01	H1609_046_0	4	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	046	0	1	01	01	H1609_046_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	046	0	1	01	01	H1609_046_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											82.83	40	40	40				75.60	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	046	0	1	01	01	H1609_046_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											645.95	25						466.34	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	047	0	1	01	01	H1609_047_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	047	0	1	01	01	H1609_047_0	4	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	047	0	1	01	01	H1609_047_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	047	0	1	01	01	H1609_047_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											71.11	35	35	35				63.10	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	047	0	1	01	01	H1609_047_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											634.72	25						524.54	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	048	0	1	01	01	H1609_048_0	6	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	048	0	1	01	01	H1609_048_0	6	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	048	0	1	01	01	H1609_048_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	048	0	1	01	01	H1609_048_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											62.33	35	35	35				59.39	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	048	0	1	01	01	H1609_048_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											618.17	25						436.64	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	049	0	1	01	01	H1609_049_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	049	0	1	01	01	H1609_049_0	4	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	049	0	1	01	01	H1609_049_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	049	0	1	01	01	H1609_049_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											80.12	40	40	40				73.51	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	049	0	1	01	01	H1609_049_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											639.47	25						463.07	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	053	0	1	01	01	H1609_053_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	053	0	1	01	01	H1609_053_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	053	0	1	01	01	H1609_053_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	053	0	1	01	01	H1609_053_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	053	0	1	01	01	H1609_053_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											997.51	33						388.23	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	054	0	1	01	01	H1609_054_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	054	0	1	01	01	H1609_054_0	4	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	054	0	1	01	01	H1609_054_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	054	0	1	01	01	H1609_054_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											81.65	40	40	40				72.32	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	054	0	1	01	01	H1609_054_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											635.27	25						522.94	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	055	0	1	01	01	H1609_055_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	055	0	1	01	01	H1609_055_0	4	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	055	0	1	01	01	H1609_055_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	055	0	1	01	01	H1609_055_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											81.65	40	40	40				72.32	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	055	0	1	01	01	H1609_055_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											635.27	25						522.94	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	056	0	1	01	01	H1609_056_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	056	0	1	01	01	H1609_056_0	4	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	056	0	1	01	01	H1609_056_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	056	0	1	01	01	H1609_056_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											81.65	40	40	40				72.32	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	056	0	1	01	01	H1609_056_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											635.27	25						522.94	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	057	0	1	01	01	H1609_057_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	057	0	1	01	01	H1609_057_0	4	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1609	057	0	1	01	01	H1609_057_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	057	0	1	01	01	H1609_057_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											81.65	40	40	40				72.32	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	057	0	1	01	01	H1609_057_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											635.27	25						522.94	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	059	0	1	01	01	H1609_059_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	059	0	1	01	01	H1609_059_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	059	0	1	01	01	H1609_059_0	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	059	0	1	01	01	H1609_059_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	059	0	1	01	01	H1609_059_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H1609	059	0	1	01	01	H1609_059_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H1609	059	0	1	01	01	H1609_059_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1098.81	33						751.16	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	060	0	1	01	01	H1609_060_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	060	0	1	01	01	H1609_060_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	060	0	1	01	01	H1609_060_0	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	060	0	1	01	01	H1609_060_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	060	0	1	01	01	H1609_060_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	060	0	1	01	01	H1609_060_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	060	0	1	01	01	H1609_060_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											997.51	33						388.23	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	001	0	1	01	01	H1610_001_0	2	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	001	0	1	01	01	H1610_001_0	2	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	001	0	1	01	01	H1610_001_0	2	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	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												
H1610	001	0	1	01	01	H1610_001_0	2	Non-Preferred Drug	4	11	1	1	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31				40.43	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	001	0	1	01	01	H1610_001_0	2	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				557.52	26																				26																		26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	002	0	1	01	01	H1610_002_0	2	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	002	0	1	01	01	H1610_002_0	2	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	002	0	1	01	01	H1610_002_0	2	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	002	0	1	01	01	H1610_002_0	2	Non-Preferred Drug	4	11	1	1	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31				44.46	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	002	0	1	01	01	H1610_002_0	2	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				549.03	26																				26																		26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	003	0	1	01	01	H1610_003_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	003	0	1	01	01	H1610_003_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	003	0	1	01	01	H1610_003_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	003	0	1	01	01	H1610_003_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31				44.46	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	003	0	1	01	01	H1610_003_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				549.03	26																				26																		26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1659	002	0	1	04	01	H1659_002_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1659	002	0	1	04	01	H1659_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				351.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1659	003	0	1	04	01	H1659_003_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1659	003	0	1	04	01	H1659_003_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	3	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												
H1664	001	0	1	01	01	H1664_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	2.00	3.00					0.00	0.00	0.00											1.00	2.00	3.00				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												
H1664	001	0	1	01	01	H1664_001_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	2.00	3.00					0.00	0.00	0.00											1.00	2.00	3.00				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		3
H1664	001	0	1	01	01	H1664_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H1664	001	0	1	01	01	H1664_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1664	001	0	1	01	01	H1664_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.20	50	50	50				95.23	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	001	0	1	01	01	H1664_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	001	0	1	01	01	H1664_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1664	004	0	1	01	01	H1664_004_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	2.00	3.00					0.00	0.00	0.00											1.00	2.00	3.00				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												
H1664	004	0	1	01	01	H1664_004_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	2.00	3.00					0.00	0.00	0.00											1.00	2.00	3.00				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		3
H1664	004	0	1	01	01	H1664_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H1664	004	0	1	01	01	H1664_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1664	004	0	1	01	01	H1664_004_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.34	45	45	45				93.97	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	004	0	1	01	01	H1664_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	004	0	1	01	01	H1664_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1664	005	0	1	01	01	H1664_005_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	005	0	1	01	01	H1664_005_0	4	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	15.00				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												
H1664	005	0	1	01	01	H1664_005_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	41.00	82.00	123.00																									41.00	82.00	123.00				41.00	82.00	82.00				41.00				41.00		1.37				1.37	1.37	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	005	0	1	01	01	H1664_005_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.20	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	005	0	1	01	01	H1664_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	005	0	1	01	01	H1664_005_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	006	0	1	01	01	H1664_006_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	006	0	1	01	01	H1664_006_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	42.00				9.00	18.00	0.00				14.00				14.00			0.47	0.3		0.47	0.3	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	006	0	1	01	01	H1664_006_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H1664	006	0	1	01	01	H1664_006_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											96.89	50	50	50				93.01	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	006	0	1	01	01	H1664_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	006	0	1	01	01	H1664_006_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	007	0	1	01	01	H1664_007_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	007	0	1	01	01	H1664_007_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	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, Select Care Drugs												
H1664	007	0	1	01	01	H1664_007_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.81	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	007	0	1	01	01	H1664_007_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	007	0	1	01	01	H1664_007_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1666	001	0	1	04	01	H1666_001_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H1666	001	0	1	04	01	H1666_001_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H1666	001	0	1	04	01	H1666_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H1666	002	0	1	04	01	H1666_002_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H1666	002	0	1	04	01	H1666_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H1666	003	0	1	04	01	H1666_003_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H1666	003	0	1	04	01	H1666_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H1666	004	0	1	04	01	H1666_004_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H1666	004	0	1	04	01	H1666_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_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												
H1666	005	0	1	04	01	H1666_005_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H1666	005	0	1	04	01	H1666_005_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H1666	005	0	1	04	01	H1666_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H1666	006	0	1	04	01	H1666_006_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H1666	006	0	1	04	01	H1666_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_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												
H1666	008	0	1	04	01	H1666_008_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H1666	008	0	1	04	01	H1666_008_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H1666	008	0	1	04	01	H1666_008_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	010	0	1	04	01	H1666_010_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	010	0	1	04	01	H1666_010_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H1666	010	0	1	04	01	H1666_010_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	010	0	1	04	01	H1666_010_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H1666	010	0	1	04	01	H1666_010_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	010	0	1	04	01	H1666_010_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	002	0	1	02	01	H1692_002_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	002	0	1	02	01	H1692_002_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H1692_002_0	2	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					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												
H1692	002	0	1	02	01	H1692_002_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H1692_002_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	002	0	1	02	01	H1692_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	002	0	1	02	01	H1692_002_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											986.68	33						466.39	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1692	003	0	1	01	01	H1692_003_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	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					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												
H1692	003	0	1	01	01	H1692_003_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1048.08	33						635.39	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	004	0	1	02	01	H1692_004_0	3	Preferred Generic	4	01	1	2	1	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	6.00	0.00					3.00			3.00			0.10	0.10		0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	004	0	1	02	01	H1692_004_0	3	Preferred Generic	4	01	1	2	1	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	6.00	0.00					3.00			3.00			0.10	0.10		0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	004	0	1	02	01	H1692_004_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	14.00	0.00					7.00	14.00	0.00											7.00	14.00	0.00				7.00	14.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	004	0	1	02	01	H1692_004_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	14.00	0.00					7.00	14.00	0.00											7.00	14.00	0.00				7.00	14.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	004	0	1	02	01	H1692_004_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	004	0	1	02	01	H1692_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H1692	004	0	1	02	01	H1692_004_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											872.74	33						513.90	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	005	0	1	01	01	H1692_005_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H1692	005	0	1	01	01	H1692_005_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H1692	005	0	1	01	01	H1692_005_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	005	0	1	01	01	H1692_005_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											37.02	25	25	25				39.05	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	005	0	1	01	01	H1692_005_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											621.38	25						410.84	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1722	002	0	1	01	01	H1722_002_0	6	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H1722	002	0	1	01	01	H1722_002_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	10.00																			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, Supplemental Drugs												
H1722	002	0	1	01	01	H1722_002_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	47.00																			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, Supplemental Drugs												
H1722	002	0	1	01	01	H1722_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H1722	002	0	1	01	01	H1722_002_0	6	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					26	26	26																		26	26	26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H1722	002	0	1	01	01	H1722_002_0	6	Supplemental Drugs	4	01	2	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H1722	002	0	1	01	01	H1722_002_0	6	Supplemental Drugs	4	01	2	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs										1		
H1723	001	0	1	48	05	H1723_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			
H1723	001	0	1	48	05	H1723_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			
H1723	001	0	1	48	05	H1723_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			
H1732	001	0	1	01	01	H1732_001_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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												
H1732	001	0	1	01	01	H1732_001_0	6	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												
H1732	001	0	1	01	01	H1732_001_0	6	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	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	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	Select Care Drugs	4	01	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	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												
H1732	003	0	1	01	01	H1732_003_0	7	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					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												
H1732	003	0	1	01	01	H1732_003_0	7	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												
H1732	003	0	1	01	01	H1732_003_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	003	0	1	01	01	H1732_003_0	7	Select Care Drugs	4	01	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	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												
H1732	004	0	1	01	01	H1732_004_0	6	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					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			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	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			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	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	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	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												
H1732	004	0	1	01	01	H1732_004_0	6	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	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	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												
H1732	005	0	1	01	01	H1732_005_0	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			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	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	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	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	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	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	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					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			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	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			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	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	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	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												
H1732	006	0	1	01	01	H1732_006_0	6	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	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	007	0	1	01	01	H1732_007_0	8	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												
H1732	007	0	1	01	01	H1732_007_0	8	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	007	0	1	01	01	H1732_007_0	8	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	105.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	007	0	1	01	01	H1732_007_0	8	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	105.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1732	007	0	1	01	01	H1732_007_0	8	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	007	0	1	01	01	H1732_007_0	8	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												
H1732	007	0	1	01	01	H1732_007_0	8	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	007	0	1	01	01	H1732_007_0	8	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	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1737	001	0	1	01	01	H1737_001_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				75.72	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	001	0	1	01	01	H1748_001_0	5	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	5	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	5	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	10.00		30.00																					30.00																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	5	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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	95.00		285.00																					285.00																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	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				995.82	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	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	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	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	Non-Preferred 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	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				990.97	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	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	6	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	6	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	6	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	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																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	6	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1001.03	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	6	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	005	0	1	01	01	H1748_005_0	5	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	005	0	1	01	01	H1748_005_0	5	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	005	0	1	01	01	H1748_005_0	5	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												
H1748	005	0	1	01	01	H1748_005_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	005	0	1	01	01	H1748_005_0	5	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				674.85	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1774	001	0	1	04	01	H1774_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1774	001	0	1	04	01	H1774_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1774	001	0	1	04	01	H1774_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1774	001	0	1	04	01	H1774_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1774	001	0	1	04	01	H1774_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1774	001	0	1	04	01	H1774_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1774	002	0	1	04	01	H1774_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1774	002	0	1	04	01	H1774_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1774	002	0	1	04	01	H1774_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1774	002	0	1	04	01	H1774_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H1774	002	0	1	04	01	H1774_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1774	002	0	1	04	01	H1774_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	9	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 Drug, Specialty Tier												
H1787	002	0	1	01	01	H1787_002_0	9	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	10.00	20.00	30.00																																						10.00			10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1787	002	0	1	01	01	H1787_002_0	9	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 Drug, Specialty Tier												
H1787	002	0	1	01	01	H1787_002_0	9	Non-Preferred Drug	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 Drug, Specialty Tier												
H1787	002	0	1	01	01	H1787_002_0	9	Specialty Tier	4	11	1	1	5	1	111		10			1	30	60	90				2	2								10	31					33	33	33																																				33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1799	001	0	1	01	01	H1799_001_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1799	001	0	1	01	01	H1799_001_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1799	001	0	1	01	01	H1799_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	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												
H1799	001	0	1	01	01	H1799_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				99.26	32	32	32																		32	32	32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1799	001	0	1	01	01	H1799_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				633.54	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1799	002	0	1	01	01	H1799_002_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1799	002	0	1	01	01	H1799_002_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1799	002	0	1	01	01	H1799_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1799	002	0	1	01	01	H1799_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1799	002	0	1	01	01	H1799_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				973.87	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1799	002	0	1	01	01	H1799_002_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1821	001	0	1	04	01	H1821_001_0	3	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												
H1821	001	0	1	04	01	H1821_001_0	3	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		
H1821	001	0	1	04	01	H1821_001_0	3	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												
H1821	001	0	1	04	01	H1821_001_0	3	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
H1821	001	0	1	04	01	H1821_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	001	0	1	04	01	H1821_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	001	0	1	04	01	H1821_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				432.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	002	0	1	04	01	H1821_002_0	3	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												
H1821	002	0	1	04	01	H1821_002_0	3	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		
H1821	002	0	1	04	01	H1821_002_0	3	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												
H1821	002	0	1	04	01	H1821_002_0	3	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
H1821	002	0	1	04	01	H1821_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	002	0	1	04	01	H1821_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	002	0	1	04	01	H1821_002_0	3	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												
H1821	003	0	1	04	01	H1821_003_0	3	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												
H1821	003	0	1	04	01	H1821_003_0	3	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		
H1821	003	0	1	04	01	H1821_003_0	3	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												
H1821	003	0	1	04	01	H1821_003_0	3	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
H1821	003	0	1	04	01	H1821_003_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	003	0	1	04	01	H1821_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	003	0	1	04	01	H1821_003_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				210.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	005	0	1	04	01	H1821_005_0	3	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												
H1821	005	0	1	04	01	H1821_005_0	3	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		
H1821	005	0	1	04	01	H1821_005_0	3	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												
H1821	005	0	1	04	01	H1821_005_0	3	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
H1821	005	0	1	04	01	H1821_005_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	005	0	1	04	01	H1821_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	005	0	1	04	01	H1821_005_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				208.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	001	0	1	01	01	H1822_001_0	6	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												
H1822	001	0	1	01	01	H1822_001_0	6	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
H1822	001	0	1	01	01	H1822_001_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	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												
H1822	001	0	1	01	01	H1822_001_0	6	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					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		
H1822	001	0	1	01	01	H1822_001_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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												
H1822	001	0	1	01	01	H1822_001_0	6	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												
H1822	001	0	1	01	01	H1822_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	002	0	1	01	01	H1822_002_0	5	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												
H1822	002	0	1	01	01	H1822_002_0	5	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		
H1822	002	0	1	01	01	H1822_002_0	5	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					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												
H1822	002	0	1	01	01	H1822_002_0	5	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					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		
H1822	002	0	1	01	01	H1822_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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												
H1822	002	0	1	01	01	H1822_002_0	5	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												
H1822	002	0	1	01	01	H1822_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	003	0	1	01	01	H1822_003_0	5	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												
H1822	003	0	1	01	01	H1822_003_0	5	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		
H1822	003	0	1	01	01	H1822_003_0	5	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					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												
H1822	003	0	1	01	01	H1822_003_0	5	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					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		
H1822	003	0	1	01	01	H1822_003_0	5	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												
H1822	003	0	1	01	01	H1822_003_0	5	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												
H1822	003	0	1	01	01	H1822_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	004	0	1	01	01	H1822_004_0	5	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					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												
H1822	004	0	1	01	01	H1822_004_0	5	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					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		3
H1822	004	0	1	01	01	H1822_004_0	5	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					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												
H1822	004	0	1	01	01	H1822_004_0	5	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												
H1822	004	0	1	01	01	H1822_004_0	5	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												
H1822	004	0	1	01	01	H1822_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1846	004	0	1	04	01	H1846_004_0	5	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	005	0	1	04	01	H1846_005_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H1846	005	0	1	04	01	H1846_005_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			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		
H1846	005	0	1	04	01	H1846_005_0	5	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												
H1846	005	0	1	04	01	H1846_005_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	005	0	1	04	01	H1846_005_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	005	0	1	04	01	H1846_005_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	006	0	1	04	01	H1846_006_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	006	0	1	04	01	H1846_006_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1846	006	0	1	04	01	H1846_006_0	5	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												
H1846	006	0	1	04	01	H1846_006_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	006	0	1	04	01	H1846_006_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H1846	006	0	1	04	01	H1846_006_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	007	0	1	04	01	H1846_007_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	007	0	1	04	01	H1846_007_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1846	007	0	1	04	01	H1846_007_0	5	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												
H1846	007	0	1	04	01	H1846_007_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H1846	007	0	1	04	01	H1846_007_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H1846	007	0	1	04	01	H1846_007_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1848	001	0	1	04	01	H1848_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	001	0	1	04	01	H1848_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	001	0	1	04	01	H1848_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1848	001	0	1	04	01	H1848_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											93.38	50	50	50				89.65	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	001	0	1	04	01	H1848_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	001	0	1	04	01	H1848_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	001	0	1	04	01	H1848_001_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1848	002	0	1	04	01	H1848_002_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	002	0	1	04	01	H1848_002_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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, Select Care Drugs												
H1848	002	0	1	04	01	H1848_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1848	002	0	1	04	01	H1848_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.75	45	45	45				94.36	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	002	0	1	04	01	H1848_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	002	0	1	04	01	H1848_002_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	002	0	1	04	01	H1848_002_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1848	003	0	1	04	01	H1848_003_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	003	0	1	04	01	H1848_003_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	7.00	14.00	21.00																									7.00	14.00	21.00				7.00	14.00	0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	003	0	1	04	01	H1848_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	003	0	1	04	01	H1848_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.70	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	003	0	1	04	01	H1848_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	003	0	1	04	01	H1848_003_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	004	0	1	04	01	H1848_004_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	004	0	1	04	01	H1848_004_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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, Select Care Drugs												
H1848	004	0	1	04	01	H1848_004_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1848	004	0	1	04	01	H1848_004_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.75	45	45	45				94.36	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	004	0	1	04	01	H1848_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	004	0	1	04	01	H1848_004_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	004	0	1	04	01	H1848_004_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1862	001	0	1	01	01	H1862_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1862	001	0	1	01	01	H1862_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H1862	001	0	1	01	01	H1862_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H1862	001	0	1	01	01	H1862_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.11	47	47	47				94.89	45	45	45										47	47	47				45	45	45			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1862	001	0	1	01	01	H1862_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1862	001	0	1	01	01	H1862_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	9	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					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, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	9	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	9	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	9	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	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					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												
H1894	002	0	1	01	01	H1894_002_0	6	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												
H1894	002	0	1	01	01	H1894_002_0	6	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	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34											50.00	27						50.00	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6	Select Care Drugs	4	01	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	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												
H1894	007	0	1	01	01	H1894_007_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	007	0	1	01	01	H1894_007_0	8	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		
H1894	007	0	1	01	01	H1894_007_0	8	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	007	0	1	01	01	H1894_007_0	8	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1894	007	0	1	01	01	H1894_007_0	8	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												
H1894	007	0	1	01	01	H1894_007_0	8	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												
H1894	007	0	1	01	01	H1894_007_0	8	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												
H1894	007	0	1	01	01	H1894_007_0	8	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												
H1894	007	0	1	01	01	H1894_007_0	8	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	
H1894	008	0	1	01	01	H1894_008_0	9	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					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, Select Care Drugs												
H1894	008	0	1	01	01	H1894_008_0	9	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	008	0	1	01	01	H1894_008_0	9	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	008	0	1	01	01	H1894_008_0	9	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	008	0	1	01	01	H1894_008_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	008	0	1	01	01	H1894_008_0	9	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	008	0	1	01	01	H1894_008_0	9	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	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	001	0	1	04	01	H1914_001_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	001	0	1	04	01	H1914_001_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H1914	001	0	1	04	01	H1914_001_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.03	47	47	47				93.86	45	45	45										47	47	47				45	45	45			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	001	0	1	04	01	H1914_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	001	0	1	04	01	H1914_001_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	001	0	1	04	01	H1914_001_0	6	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1914	002	0	1	04	01	H1914_002_0	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	002	0	1	04	01	H1914_002_0	6	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	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	002	0	1	04	01	H1914_002_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H1914	002	0	1	04	01	H1914_002_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.13	50	50	50				90.37	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	002	0	1	04	01	H1914_002_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	002	0	1	04	01	H1914_002_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	002	0	1	04	01	H1914_002_0	6	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1914	004	0	1	04	01	H1914_004_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	004	0	1	04	01	H1914_004_0	6	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	17.00	34.00	51.00																									17.00	34.00	51.00				17.00	34.00	0.00				17.00				17.00		0.57				0.57	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	004	0	1	04	01	H1914_004_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	43.00	86.00	129.00																									43.00	86.00	129.00				43.00	86.00	86.00				43.00				43.00		1.43				1.43	1.43	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	004	0	1	04	01	H1914_004_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				96.73	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	004	0	1	04	01	H1914_004_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	004	0	1	04	01	H1914_004_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1944	001	0	1	01	01	H1944_001_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	2	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	001	0	1	01	01	H1944_001_0	2	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	2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				200.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	2	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	004	0	1	01	01	H1944_004_0	2	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	2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				132.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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		
H1944	005	0	1	01	01	H1944_005_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	005	0	1	01	01	H1944_005_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				441.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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		
H1944	006	0	1	01	01	H1944_006_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	006	0	1	01	01	H1944_006_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				229.00	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	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	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	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		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												
H1944	009	0	1	01	01	H1944_009_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		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		3
H1944	009	0	1	01	01	H1944_009_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				628.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				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	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	010	0	1	01	01	H1944_010_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	010	0	1	01	01	H1944_010_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				484.00	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	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	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	011	0	1	01	01	H1944_011_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	011	0	1	01	01	H1944_011_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	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												
H1944	014	0	1	02	01	H1944_014_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	02	01	H1944_014_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	014	0	1	02	01	H1944_014_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	02	01	H1944_014_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	014	0	1	02	01	H1944_014_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	02	01	H1944_014_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				382.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	02	01	H1944_016_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	02	01	H1944_016_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	016	0	1	02	01	H1944_016_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	02	01	H1944_016_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	016	0	1	02	01	H1944_016_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	02	01	H1944_016_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	02	01	H1944_016_0	3	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												
H1944	017	0	1	01	01	H1944_017_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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		
H1944	017	0	1	01	01	H1944_017_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	017	0	1	01	01	H1944_017_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				372.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	2	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	018	0	1	01	01	H1944_018_0	2	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	2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				375.00	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	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	024	0	1	01	01	H1944_024_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	024	0	1	01	01	H1944_024_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	01	01	H1944_024_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	024	0	1	01	01	H1944_024_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	01	01	H1944_024_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				562.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	01	01	H1944_028_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	01	01	H1944_028_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	028	0	1	01	01	H1944_028_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	01	01	H1944_028_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	028	0	1	01	01	H1944_028_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	01	01	H1944_028_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	01	01	H1944_028_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				392.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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		
H1944	031	0	1	01	01	H1944_031_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	031	0	1	01	01	H1944_031_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	031	0	1	01	01	H1944_031_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	031	0	1	01	01	H1944_031_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	031	0	1	01	01	H1944_031_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				621.00	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	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	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	032	0	1	01	01	H1944_032_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	032	0	1	01	01	H1944_032_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	032	0	1	01	01	H1944_032_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	032	0	1	01	01	H1944_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	032	0	1	01	01	H1944_032_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				429.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	033	0	1	01	01	H1944_033_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	033	0	1	01	01	H1944_033_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	033	0	1	01	01	H1944_033_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	033	0	1	01	01	H1944_033_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	033	0	1	01	01	H1944_033_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	033	0	1	01	01	H1944_033_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	033	0	1	01	01	H1944_033_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				579.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1947	001	0	1	01	01	H1947_001_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					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												
H1947	001	0	1	01	01	H1947_001_0	7	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												
H1947	001	0	1	01	01	H1947_001_0	7	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	120.00					40.00	120.00	120.00																40.00				40.00			1.33	1.33	1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1947	001	0	1	01	01	H1947_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1947	001	0	1	01	01	H1947_001_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				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												
H1951	013	0	1	01	01	H1951_013_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	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												
H1951	028	0	1	01	01	H1951_028_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	033	0	1	01	01	H1951_033_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	034	0	1	01	01	H1951_034_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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												
H1951	041	0	1	01	01	H1951_041_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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												
H1951	041	0	1	01	01	H1951_041_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												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	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	6	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	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	6	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	6	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	6	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	6	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	6	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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	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												
H1951	047	1	1	01	01	H1951_047_1	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_1	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_1	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	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												
H1951	049	1	1	01	01	H1951_049_1	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_2	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	051	0	1	01	01	H1951_051_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	051	0	1	01	01	H1951_051_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	051	0	1	01	01	H1951_051_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	052	0	1	01	01	H1951_052_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	052	0	1	01	01	H1951_052_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	052	0	1	01	01	H1951_052_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	053	0	1	01	01	H1951_053_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	053	0	1	01	01	H1951_053_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	053	0	1	01	01	H1951_053_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	053	0	1	01	01	H1951_053_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	053	0	1	01	01	H1951_053_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	054	0	1	01	01	H1951_054_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	054	0	1	01	01	H1951_054_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	054	0	1	01	01	H1951_054_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	054	0	1	01	01	H1951_054_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	054	0	1	01	01	H1951_054_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	055	0	1	01	01	H1951_055_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	055	0	1	01	01	H1951_055_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	055	0	1	01	01	H1951_055_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	055	0	1	01	01	H1951_055_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	055	0	1	01	01	H1951_055_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	056	0	1	01	01	H1951_056_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					15.00		45.00											18.00		54.00				15.00		0.00				18.00				18.00			0.60	0.50		0.60	0.50	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	056	0	1	01	01	H1951_056_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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												
H1951	056	0	1	01	01	H1951_056_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	056	0	1	01	01	H1951_056_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	056	0	1	01	01	H1951_056_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	1	1	01	01	H1961_014_1	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	014	1	1	01	01	H1961_014_1	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						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	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				328.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	2	1	01	01	H1961_014_2	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	014	2	1	01	01	H1961_014_2	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						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	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				328.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	3	1	01	01	H1961_014_3	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	3	1	01	01	H1961_014_3	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	3	1	01	01	H1961_014_3	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	3	1	01	01	H1961_014_3	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	014	3	1	01	01	H1961_014_3	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						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	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				328.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	4	1	01	01	H1961_014_4	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	4	1	01	01	H1961_014_4	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	4	1	01	01	H1961_014_4	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	4	1	01	01	H1961_014_4	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	014	4	1	01	01	H1961_014_4	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						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	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				328.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	01	01	H1961_017_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	01	01	H1961_017_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	017	0	1	01	01	H1961_017_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	01	01	H1961_017_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	017	0	1	01	01	H1961_017_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						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	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				452.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	002	0	1	01	01	H1969_002_0	7	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	30.00					.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												
H1969	002	0	1	01	01	H1969_002_0	7	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	60.00					12.00	24.00	36.00					12.00	24.00	0.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	002	0	1	01	01	H1969_002_0	7	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					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												
H1969	002	0	1	01	01	H1969_002_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1083.71	30						1083.71	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	004	0	1	01	01	H1969_004_0	7	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					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												
H1969	004	0	1	01	01	H1969_004_0	7	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					8.00	16.00	16.00					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												
H1969	004	0	1	01	01	H1969_004_0	7	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1119.84	31						1119.84	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	3	1	01	01	H1969_007_3	8	Preferred Generic	4	01	3	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					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												
H1969	007	3	1	01	01	H1969_007_3	8	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	60.00					12.00	24.00	36.00					12.00	24.00	0.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	3	1	01	01	H1969_007_3	8	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					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												
H1969	007	3	1	01	01	H1969_007_3	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1119.84	31						1119.84	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	4	1	01	01	H1969_007_4	8	Preferred Generic	4	01	3	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					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												
H1969	007	4	1	01	01	H1969_007_4	8	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	60.00					12.00	24.00	36.00					12.00	24.00	0.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	4	1	01	01	H1969_007_4	8	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					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												
H1969	007	4	1	01	01	H1969_007_4	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1119.84	31						1119.84	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	008	1	1	01	01	H1969_008_1	8	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					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												
H1969	008	1	1	01	01	H1969_008_1	8	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					8.00	16.00	16.00					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												
H1969	008	1	1	01	01	H1969_008_1	8	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	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1119.84	31						1119.84	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	008	2	1	01	01	H1969_008_2	8	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					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												
H1969	008	2	1	01	01	H1969_008_2	8	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					8.00	16.00	16.00					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												
H1969	008	2	1	01	01	H1969_008_2	8	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	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1119.84	31						1119.84	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	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	001	0	1	01	01	H1993_001_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	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	8	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	8	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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1075.19	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	002	0	1	01	01	H1993_002_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	8	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	8	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	8	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	8	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				91.65	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	8	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				75.41	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				868.11	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	003	0	1	01	01	H1993_003_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	003	0	1	01	01	H1993_003_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	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	8	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	8	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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1082.73	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	004	0	1	01	01	H1993_004_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	8	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	8	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	8	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	8	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				91.65	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	8	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				73.48	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				853.95	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	10	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	10	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	10	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	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1338.77	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	9	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	9	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	9	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	9	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	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1229.08	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	9	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	003	0	1	01	01	H1994_003_0	9	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	003	0	1	01	01	H1994_003_0	9	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	9	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	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1258.29	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	9	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	9	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	9	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	9	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	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1536.92	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	9	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	9	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	9	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	9	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	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1602.25	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	10	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	10	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	10	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	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1135.87	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	012	0	1	01	01	H1994_012_0	10	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	10	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	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				2529.12	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	013	0	1	01	01	H1994_013_0	9	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	9	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	9	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	013	0	1	01	01	H1994_013_0	9	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	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	013	0	1	01	01	H1994_013_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	013	0	1	01	01	H1994_013_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1485.32	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	014	0	1	01	01	H1994_014_0	9	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	9	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	9	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	014	0	1	01	01	H1994_014_0	9	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	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	014	0	1	01	01	H1994_014_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	014	0	1	01	01	H1994_014_0	9	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	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					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												
H1997	002	0	1	01	01	H1997_002_0	7	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					12.00	24.00	24.00					12.00	24.00	24.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	7	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1119.84	31						1119.84	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	009	0	1	01	01	H1997_009_0	7	Preferred Generic	4	01	3	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					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												
H1997	009	0	1	01	01	H1997_009_0	7	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	60.00					12.00	24.00	36.00					12.00	24.00	0.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	009	0	1	01	01	H1997_009_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								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												
H1997	009	0	1	01	01	H1997_009_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1011.47	28						1011.47	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	010	0	1	01	01	H1997_010_0	8	Preferred Generic	4	01	3	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					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												
H1997	010	0	1	01	01	H1997_010_0	8	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	60.00					12.00	24.00	36.00					12.00	24.00	0.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	010	0	1	01	01	H1997_010_0	8	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					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												
H1997	010	0	1	01	01	H1997_010_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1011.47	28						1011.47	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	011	0	1	01	01	H1997_011_0	8	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					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												
H1997	011	0	1	01	01	H1997_011_0	8	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					12.00	24.00	24.00					12.00	24.00	24.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	011	0	1	01	01	H1997_011_0	8	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	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1119.84	31						1119.84	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	3	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		
H2001	001	0	1	04	01	H2001_001_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	001	0	1	04	01	H2001_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				223.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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		
H2001	010	0	1	04	01	H2001_010_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	010	0	1	04	01	H2001_010_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				147.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	4	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												
H2001	017	0	1	04	01	H2001_017_0	4	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		
H2001	017	0	1	04	01	H2001_017_0	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				521.00	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	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	018	0	1	04	01	H2001_018_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2001	018	0	1	04	01	H2001_018_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	018	0	1	04	01	H2001_018_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	018	0	1	04	01	H2001_018_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	018	0	1	04	01	H2001_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	018	0	1	04	01	H2001_018_0	3	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												
H2001	019	0	1	04	01	H2001_019_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2001	019	0	1	04	01	H2001_019_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	019	0	1	04	01	H2001_019_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				260.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	001	0	1	04	01	H2020_001_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	0.00					0.00	0.00	0.00											9.00	18.00	0.00				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												
H2020	001	0	1	04	01	H2020_001_0	7	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	0.00					0.00	0.00	0.00											9.00	18.00	0.00				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		
H2020	001	0	1	04	01	H2020_001_0	7	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								14.00	28.00	42.00					7.00	14.00	21.00											14.00	28.00	42.00				7.00	14.00	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	Generic	4	01	3	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								14.00	28.00	42.00					7.00	14.00	21.00											14.00	28.00	42.00				2.00	4.00	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	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	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	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											960.95	33	33	33				960.95	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	002	0	1	04	01	H2020_002_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00	18.00	27.00				2.00	4.00	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	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00	18.00	27.00				2.00	4.00	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	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		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												
H2020	002	0	1	04	01	H2020_002_0	6	Generic	4	01	3	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		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		3
H2020	002	0	1	04	01	H2020_002_0	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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												
H2020	002	0	1	04	01	H2020_002_0	6	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											933.70	33	33	33				933.70	33	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	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	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												
H2020	003	0	1	04	01	H2020_003_0	7	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	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										1		
H2020	003	0	1	04	01	H2020_003_0	7	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		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												
H2020	003	0	1	04	01	H2020_003_0	7	Generic	4	01	3	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		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		3
H2020	003	0	1	04	01	H2020_003_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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												
H2020	003	0	1	04	01	H2020_003_0	7	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											925.77	31	31	31				925.77	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	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	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												
H2020	005	0	1	04	01	H2020_005_0	6	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	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										1		
H2020	005	0	1	04	01	H2020_005_0	6	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		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												
H2020	005	0	1	04	01	H2020_005_0	6	Generic	4	01	3	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		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		3
H2020	005	0	1	04	01	H2020_005_0	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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												
H2020	005	0	1	04	01	H2020_005_0	6	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											967.05	33	33	33				967.05	33	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	3	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	3	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2029	001	0	1	04	01	H2029_001_0	3	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	4	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	4	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	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	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	4	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	4	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	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	6.00																			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	4	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	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	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	4	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	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	003	0	1	04	01	H2032_003_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	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	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	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	6	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	6	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	02	01	H2056_001_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	001	0	1	02	01	H2056_001_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H2056_001_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	001	0	1	02	01	H2056_001_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H2056_001_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	001	0	1	02	01	H2056_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	001	0	1	02	01	H2056_001_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											979.22	33						454.86	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	002	0	1	02	01	H2056_002_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	002	0	1	02	01	H2056_002_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H2056_002_0	2	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					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												
H2056	002	0	1	02	01	H2056_002_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H2056_002_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	002	0	1	02	01	H2056_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	002	0	1	02	01	H2056_002_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											907.96	33						483.22	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	003	0	1	02	01	H2056_003_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	003	0	1	02	01	H2056_003_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H2056_003_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	003	0	1	02	01	H2056_003_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H2056_003_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	003	0	1	02	01	H2056_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	003	0	1	02	01	H2056_003_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											809.48	33						479.22	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	004	0	1	02	01	H2056_004_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	004	0	1	02	01	H2056_004_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H2056_004_0	2	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					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												
H2056	004	0	1	02	01	H2056_004_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H2056_004_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	004	0	1	02	01	H2056_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	004	0	1	02	01	H2056_004_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											972.19	33						546.61	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	005	0	1	02	01	H2056_005_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	005	0	1	02	01	H2056_005_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H2056_005_0	3	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					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												
H2056	005	0	1	02	01	H2056_005_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H2056_005_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	005	0	1	02	01	H2056_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	005	0	1	02	01	H2056_005_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1030.72	33						377.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	3	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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											892.30	33						838.45	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3	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	3	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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											846.96	33						757.94	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	029	0	1	01	01	H2108_029_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	3	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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											538.20	33						685.04	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	3	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	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	3	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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											761.35	33						684.54	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	3	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	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	3	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	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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											685.95	28						538.29	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	036	0	1	01	01	H2108_036_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	3	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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											892.30	33						838.45	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2117	001	0	1	04	01	H2117_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2117	001	0	1	04	01	H2117_001_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2117	001	0	1	04	01	H2117_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H2117	001	0	1	04	01	H2117_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H2117	001	0	1	04	01	H2117_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.76	45	45	45				94.37	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2117	001	0	1	04	01	H2117_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2117	001	0	1	04	01	H2117_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2117	001	0	1	04	01	H2117_001_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2117	002	0	1	04	01	H2117_002_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2117	002	0	1	04	01	H2117_002_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	7.00	14.00	21.00																									7.00	14.00	21.00				7.00	14.00	0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2117	002	0	1	04	01	H2117_002_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2117	002	0	1	04	01	H2117_002_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.70	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2117	002	0	1	04	01	H2117_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2117	002	0	1	04	01	H2117_002_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2117	004	0	1	04	01	H2117_004_0	4	Preferred Generic	4	11	3	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, Select Care Drugs												
H2117	004	0	1	04	01	H2117_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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												
H2117	004	0	1	04	01	H2117_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H2117	004	0	1	04	01	H2117_004_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											96.77	45	45	45				92.47	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2117	004	0	1	04	01	H2117_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2117	004	0	1	04	01	H2117_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	001	0	1	04	01	H2128_001_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	001	0	1	04	01	H2128_001_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	001	0	1	04	01	H2128_001_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	43.00	86.00	129.00																									43.00	86.00	129.00				43.00	86.00	86.00				43.00				43.00		1.43				1.43	1.43	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	001	0	1	04	01	H2128_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.10	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	001	0	1	04	01	H2128_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	001	0	1	04	01	H2128_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	002	0	1	04	01	H2128_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	002	0	1	04	01	H2128_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H2128	002	0	1	04	01	H2128_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H2128	002	0	1	04	01	H2128_002_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.32	45	45	45				94.90	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	002	0	1	04	01	H2128_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	002	0	1	04	01	H2128_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	003	0	1	04	01	H2128_003_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	003	0	1	04	01	H2128_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H2128	003	0	1	04	01	H2128_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H2128	003	0	1	04	01	H2128_003_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.22	45	45	45				94.81	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	003	0	1	04	01	H2128_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	003	0	1	04	01	H2128_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	004	0	1	04	01	H2128_004_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	004	0	1	04	01	H2128_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H2128	004	0	1	04	01	H2128_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H2128	004	0	1	04	01	H2128_004_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											93.74	50	50	50				89.99	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	004	0	1	04	01	H2128_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	004	0	1	04	01	H2128_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2128	004	0	1	04	01	H2128_004_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2134	001	0	1	01	01	H2134_001_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	001	0	1	01	01	H2134_001_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	001	0	1	01	01	H2134_001_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	001	0	1	01	01	H2134_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.68	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	001	0	1	01	01	H2134_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	001	0	1	01	01	H2134_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	002	0	1	01	01	H2134_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	002	0	1	01	01	H2134_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	42.00				9.00	18.00	0.00				14.00				14.00			0.47	0.3		0.47	0.3	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	002	0	1	01	01	H2134_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H2134	002	0	1	01	01	H2134_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H2134	002	0	1	01	01	H2134_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	002	0	1	01	01	H2134_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	003	0	1	01	01	H2134_003_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	003	0	1	01	01	H2134_003_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	003	0	1	01	01	H2134_003_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.29	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	003	0	1	01	01	H2134_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	003	0	1	01	01	H2134_003_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	004	0	1	01	01	H2134_004_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	004	0	1	01	01	H2134_004_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	004	0	1	01	01	H2134_004_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H2134	004	0	1	01	01	H2134_004_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.91	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	004	0	1	01	01	H2134_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	004	0	1	01	01	H2134_004_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	005	0	1	01	01	H2134_005_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	005	0	1	01	01	H2134_005_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	42.00				9.00	18.00	0.00				14.00				14.00			0.47	0.3		0.47	0.3	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	Preferred Brand	4	11	1	2	3	1		111	01		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												
H2134	005	0	1	01	01	H2134_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H2134	005	0	1	01	01	H2134_005_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	005	0	1	01	01	H2134_005_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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	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	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	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	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	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	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	20.00	40.00	40.00																			20.00	30.00	30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2161	003	0	1	01	01	H2161_003_0	5	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	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	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	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2162	001	0	1	01	01	H2162_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H2162	001	0	1	01	01	H2162_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H2162	001	0	1	01	01	H2162_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.27	45	45	45				93.90	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2162	001	0	1	01	01	H2162_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2162	001	0	1	01	01	H2162_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2162	002	0	1	01	01	H2162_002_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2162	002	0	1	01	01	H2162_002_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	12.00	24.00	36.00																									12.00	24.00	36.00				12.00	24.00	0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2162	002	0	1	01	01	H2162_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2162	002	0	1	01	01	H2162_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.33	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2162	002	0	1	01	01	H2162_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2162	002	0	1	01	01	H2162_002_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2171	001	0	1	01	01	H2171_001_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	8	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		
H2171	001	0	1	01	01	H2171_001_0	8	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	24.00																			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												
H2171	001	0	1	01	01	H2171_001_0	8	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	24.00																			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	
H2171	001	0	1	01	01	H2171_001_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H2171	001	0	1	01	01	H2171_001_0	8	Preferred Brand	4	11	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	90.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2171	001	0	1	01	01	H2171_001_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	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												
H2171	001	0	1	01	01	H2171_001_0	8	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1680.34	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2171	003	0	1	01	01	H2171_003_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2171	003	0	1	01	01	H2171_003_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2171	003	0	1	01	01	H2171_003_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			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												
H2171	003	0	1	01	01	H2171_003_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			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										2	3	
H2171	003	0	1	01	01	H2171_003_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	003	0	1	01	01	H2171_003_0	6	Preferred Brand	4	11	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	80.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2171	003	0	1	01	01	H2171_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	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												
H2171	003	0	1	01	01	H2171_003_0	6	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		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	7	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	7	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	001	0	1	01	01	H2172_001_0	7	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	7	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	001	0	1	01	01	H2172_001_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	7	Non-Preferred Brand	4	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	7	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	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	7	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	7	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	002	0	1	01	01	H2172_002_0	7	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	002	0	1	01	01	H2172_002_0	7	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	002	0	1	01	01	H2172_002_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7	Non-Preferred Brand	4	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	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	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	003	0	1	01	01	H2172_003_0	7	Preferred Generic	4	11	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	7	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_0	7	Non-Preferred Brand	4	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	7	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	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_0	7	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_0	7	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	004	0	1	01	01	H2172_004_0	8	Preferred Generic	4	11	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	8	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	8	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	8	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	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	8	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	01	01	H2172_004_0	8	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	006	0	1	01	01	H2172_006_0	8	Preferred Generic	4	11	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	8	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	8	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	8	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	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	8	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	8	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	008	0	1	01	01	H2172_008_0	8	Preferred Generic	4	11	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	8	Preferred Generic	4	11	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	8	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	8	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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	8	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	8	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	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	8	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	008	0	1	01	01	H2172_008_0	8	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	009	0	1	01	01	H2172_009_0	7	Preferred Generic	4	11	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	7	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	01	01	H2172_009_0	7	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	7	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	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	7	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	01	01	H2172_009_0	7	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	010	0	1	01	01	H2172_010_0	7	Preferred Generic	4	11	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	7	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	010	0	1	01	01	H2172_010_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	01	01	H2172_010_0	7	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	7	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	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	7	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	01	01	H2172_010_0	7	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	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	7	Preferred Generic	4	11	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	7	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	7	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	7	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	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	7	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	7	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	012	0	1	01	01	H2172_012_0	7	Preferred Generic	4	11	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	7	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	01	01	H2172_012_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	01	01	H2172_012_0	7	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	7	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	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	7	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	01	01	H2172_012_0	7	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2174	001	0	1	01	01	H2174_001_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2174	001	0	1	01	01	H2174_001_0	4	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	15.00				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												
H2174	001	0	1	01	01	H2174_001_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	29.00	58.00	87.00																									29.00	58.00	87.00				29.00	58.00	58.00				29.00				29.00		0.97				0.97	0.97	0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2174	001	0	1	01	01	H2174_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				84.52	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2174	001	0	1	01	01	H2174_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2174	001	0	1	01	01	H2174_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2196	001	0	1	01	01	H2196_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	001	0	1	01	01	H2196_001_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2196	001	0	1	01	01	H2196_001_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	001	0	1	01	01	H2196_001_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2196	001	0	1	01	01	H2196_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	001	0	1	01	01	H2196_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	001	0	1	01	01	H2196_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				449.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	002	0	1	01	01	H2196_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	002	0	1	01	01	H2196_002_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2196	002	0	1	01	01	H2196_002_0	3	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	3	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	002	0	1	01	01	H2196_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	002	0	1	01	01	H2196_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				431.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2225	001	0	1	01	01	H2225_001_0	11	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	11	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	11	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	11	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	11	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3	Generic	4	01	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3	Specialty Tier	4	11	1	1	5	1	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												
H2228	017	0	1	04	01	H2228_017_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	3	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												
H2228	017	0	1	04	01	H2228_017_0	3	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
H2228	017	0	1	04	01	H2228_017_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	3	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	018	0	1	04	01	H2228_018_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	018	0	1	04	01	H2228_018_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	018	0	1	04	01	H2228_018_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	3	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												
H2228	019	0	1	04	01	H2228_019_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	019	0	1	04	01	H2228_019_0	3	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	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	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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				344.00	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	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	020	0	1	04	01	H2228_020_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	020	0	1	04	01	H2228_020_0	3	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	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	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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		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	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												
H2228	021	0	1	04	01	H2228_021_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	021	0	1	04	01	H2228_021_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	021	0	1	04	01	H2228_021_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	3	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												
H2228	022	0	1	04	01	H2228_022_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	022	0	1	04	01	H2228_022_0	3	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	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	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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				425.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	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	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	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		
H2228	023	0	1	04	01	H2228_023_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	3	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												
H2228	024	0	1	04	01	H2228_024_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H2228	024	0	1	04	01	H2228_024_0	3	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												
H2228	024	0	1	04	01	H2228_024_0	3	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
H2228	024	0	1	04	01	H2228_024_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				245.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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												
H2228	029	0	1	04	01	H2228_029_0	3	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		
H2228	029	0	1	04	01	H2228_029_0	3	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	029	0	1	04	01	H2228_029_0	3	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	029	0	1	04	01	H2228_029_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				346.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	3	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												
H2228	030	0	1	04	01	H2228_030_0	3	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		
H2228	030	0	1	04	01	H2228_030_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		12.50																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		12.50																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	030	0	1	04	01	H2228_030_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	3	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												
H2228	031	0	1	04	01	H2228_031_0	4	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												
H2228	031	0	1	04	01	H2228_031_0	4	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		
H2228	031	0	1	04	01	H2228_031_0	4	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	4	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	4	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	4	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	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				334.00	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	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												
H2228	032	0	1	04	01	H2228_032_0	3	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		
H2228	032	0	1	04	01	H2228_032_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				475.00	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	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	035	0	1	04	01	H2228_035_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	035	0	1	04	01	H2228_035_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				563.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		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	036	0	1	04	01	H2228_036_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	036	0	1	04	01	H2228_036_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	036	0	1	04	01	H2228_036_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				316.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		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	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	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		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												
H2228	037	0	1	04	01	H2228_037_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		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		3
H2228	037	0	1	04	01	H2228_037_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	3	Specialty Tier	4	11	1	1	5	1	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												
H2228	039	0	1	04	01	H2228_039_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3	Generic	4	01	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				265.00	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	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												
H2228	047	0	1	04	01	H2228_047_0	3	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		
H2228	047	0	1	04	01	H2228_047_0	3	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	047	0	1	04	01	H2228_047_0	3	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	047	0	1	04	01	H2228_047_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				537.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	3	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												
H2228	049	0	1	04	01	H2228_049_0	3	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		
H2228	049	0	1	04	01	H2228_049_0	3	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	049	0	1	04	01	H2228_049_0	3	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	049	0	1	04	01	H2228_049_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	3	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												
H2228	064	0	1	04	01	H2228_064_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	064	0	1	04	01	H2228_064_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	064	0	1	04	01	H2228_064_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				372.00	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	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	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	065	0	1	04	01	H2228_065_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	065	0	1	04	01	H2228_065_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				423.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	066	0	1	04	01	H2228_066_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	066	0	1	04	01	H2228_066_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	066	0	1	04	01	H2228_066_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	066	0	1	04	01	H2228_066_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	066	0	1	04	01	H2228_066_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	066	0	1	04	01	H2228_066_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	066	0	1	04	01	H2228_066_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				387.00	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	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	067	0	1	04	01	H2228_067_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H2228	067	0	1	04	01	H2228_067_0	3	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												
H2228	067	0	1	04	01	H2228_067_0	3	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
H2228	067	0	1	04	01	H2228_067_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	067	0	1	04	01	H2228_067_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	067	0	1	04	01	H2228_067_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				364.00	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	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												
H2228	068	0	1	04	01	H2228_068_0	3	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		
H2228	068	0	1	04	01	H2228_068_0	3	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												
H2228	068	0	1	04	01	H2228_068_0	3	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
H2228	068	0	1	04	01	H2228_068_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	068	0	1	04	01	H2228_068_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	068	0	1	04	01	H2228_068_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				258.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	071	0	1	04	01	H2228_071_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	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	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	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										1		
H2228	071	0	1	04	01	H2228_071_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	071	0	1	04	01	H2228_071_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	071	0	1	04	01	H2228_071_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				499.00	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	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	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		
H2228	074	0	1	04	01	H2228_074_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											370.00	30						245.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	075	0	1	04	01	H2228_075_0	3	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	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		
H2228	075	0	1	04	01	H2228_075_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											499.00	33						411.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	076	0	1	04	01	H2228_076_0	3	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												
H2228	076	0	1	04	01	H2228_076_0	3	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		
H2228	076	0	1	04	01	H2228_076_0	3	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												
H2228	076	0	1	04	01	H2228_076_0	3	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
H2228	076	0	1	04	01	H2228_076_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	076	0	1	04	01	H2228_076_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	076	0	1	04	01	H2228_076_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				540.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	077	0	1	04	01	H2228_077_0	3	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	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		
H2228	077	0	1	04	01	H2228_077_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											194.00	30						373.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	079	0	1	04	01	H2228_079_0	3	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	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		
H2228	079	0	1	04	01	H2228_079_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											351.00	29						350.00	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	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	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	080	0	1	04	01	H2228_080_0	3	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	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	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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				402.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	081	0	1	04	01	H2228_081_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	081	0	1	04	01	H2228_081_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				320.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	082	0	1	04	01	H2228_082_0	3	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												
H2228	082	0	1	04	01	H2228_082_0	3	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		
H2228	082	0	1	04	01	H2228_082_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	082	0	1	04	01	H2228_082_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	082	0	1	04	01	H2228_082_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				450.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	083	0	1	04	01	H2228_083_0	3	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	083	0	1	04	01	H2228_083_0	3	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		
H2228	083	0	1	04	01	H2228_083_0	3	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	083	0	1	04	01	H2228_083_0	3	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	083	0	1	04	01	H2228_083_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					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	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											522.00	33						159.00	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	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	084	0	1	04	01	H2228_084_0	3	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		
H2228	084	0	1	04	01	H2228_084_0	3	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	084	0	1	04	01	H2228_084_0	3	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	084	0	1	04	01	H2228_084_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					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	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	084	0	1	04	01	H2228_084_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											359.00	28						258.00	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	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	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	085	0	1	04	01	H2228_085_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				491.00	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	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	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	086	0	1	04	01	H2228_086_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	086	0	1	04	01	H2228_086_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	086	0	1	04	01	H2228_086_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	086	0	1	04	01	H2228_086_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	086	0	1	04	01	H2228_086_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				508.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	093	0	1	04	01	H2228_093_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	093	0	1	04	01	H2228_093_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				379.00	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	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												
H2228	094	0	1	04	01	H2228_094_0	3	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		
H2228	094	0	1	04	01	H2228_094_0	3	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												
H2228	094	0	1	04	01	H2228_094_0	3	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
H2228	094	0	1	04	01	H2228_094_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	094	0	1	04	01	H2228_094_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	094	0	1	04	01	H2228_094_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				313.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	096	0	1	04	01	H2228_096_0	3	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	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		
H2228	096	0	1	04	01	H2228_096_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											428.00	33						255.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	097	0	1	04	01	H2228_097_0	3	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	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		
H2228	097	0	1	04	01	H2228_097_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											458.00	33						313.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	099	0	1	04	01	H2228_099_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	099	0	1	04	01	H2228_099_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	099	0	1	04	01	H2228_099_0	3	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												
H2228	099	0	1	04	01	H2228_099_0	3	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
H2228	099	0	1	04	01	H2228_099_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	099	0	1	04	01	H2228_099_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	099	0	1	04	01	H2228_099_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				355.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	100	0	1	04	01	H2228_100_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	100	0	1	04	01	H2228_100_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	100	0	1	04	01	H2228_100_0	3	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												
H2228	100	0	1	04	01	H2228_100_0	3	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
H2228	100	0	1	04	01	H2228_100_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	100	0	1	04	01	H2228_100_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	100	0	1	04	01	H2228_100_0	3	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												
H2228	101	0	1	04	01	H2228_101_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	101	0	1	04	01	H2228_101_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	101	0	1	04	01	H2228_101_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	20.00		40.00																											60.00						0.00				20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	101	0	1	04	01	H2228_101_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	20.00		40.00																											60.00						0.00				20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	101	0	1	04	01	H2228_101_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	101	0	1	04	01	H2228_101_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	101	0	1	04	01	H2228_101_0	3	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												
H2228	102	0	1	04	01	H2228_102_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	102	0	1	04	01	H2228_102_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	102	0	1	04	01	H2228_102_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	20.00		40.00																											60.00						0.00				20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	102	0	1	04	01	H2228_102_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	20.00		40.00																											60.00						0.00				20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	102	0	1	04	01	H2228_102_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	102	0	1	04	01	H2228_102_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	102	0	1	04	01	H2228_102_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				429.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	110	0	1	04	01	H2228_110_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	110	0	1	04	01	H2228_110_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	110	0	1	04	01	H2228_110_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	110	0	1	04	01	H2228_110_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	110	0	1	04	01	H2228_110_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	110	0	1	04	01	H2228_110_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	110	0	1	04	01	H2228_110_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				260.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	111	0	1	04	01	H2228_111_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	111	0	1	04	01	H2228_111_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	111	0	1	04	01	H2228_111_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	111	0	1	04	01	H2228_111_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	111	0	1	04	01	H2228_111_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	111	0	1	04	01	H2228_111_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	111	0	1	04	01	H2228_111_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				385.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	115	0	1	04	01	H2228_115_0	3	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												
H2228	115	0	1	04	01	H2228_115_0	3	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		
H2228	115	0	1	04	01	H2228_115_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	115	0	1	04	01	H2228_115_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	115	0	1	04	01	H2228_115_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	115	0	1	04	01	H2228_115_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	115	0	1	04	01	H2228_115_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				520.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	116	0	1	04	01	H2228_116_0	3	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												
H2228	116	0	1	04	01	H2228_116_0	3	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		
H2228	116	0	1	04	01	H2228_116_0	3	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												
H2228	116	0	1	04	01	H2228_116_0	3	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
H2228	116	0	1	04	01	H2228_116_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	116	0	1	04	01	H2228_116_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	116	0	1	04	01	H2228_116_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				510.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	117	0	1	04	01	H2228_117_0	3	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												
H2228	117	0	1	04	01	H2228_117_0	3	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		
H2228	117	0	1	04	01	H2228_117_0	3	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												
H2228	117	0	1	04	01	H2228_117_0	3	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
H2228	117	0	1	04	01	H2228_117_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	117	0	1	04	01	H2228_117_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	117	0	1	04	01	H2228_117_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				510.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	118	0	1	04	01	H2228_118_0	3	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												
H2228	118	0	1	04	01	H2228_118_0	3	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		
H2228	118	0	1	04	01	H2228_118_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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												
H2228	118	0	1	04	01	H2228_118_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H2228	118	0	1	04	01	H2228_118_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	118	0	1	04	01	H2228_118_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	118	0	1	04	01	H2228_118_0	3	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												
H2230	002	0	1	04	01	H2230_002_0	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											5.00	5.00	5.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	15.00	15.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	89.00	89.00				42.00	84.00	84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	6	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	195.00	195.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	6	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											5.00	5.00	5.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.17	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	6	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											15.00	25.00	25.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.50	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	89.00	89.00				42.00	84.00	84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	6	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	195.00	195.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	018	1	1	04	01	H2230_018_1	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					0.00	0.00	0.00											5.00	5.00	5.00				0.00	0.00	0.00				8.00				8.00			0.27	0.00		0.17	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	018	1	1	04	01	H2230_018_1	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					6.00	12.00	18.00											11.00	17.00	17.00				6.00	12.00	12.00				12.00				12.00			0.40	0.20		0.37	0.20	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	018	1	1	04	01	H2230_018_1	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	89.00	89.00				42.00	84.00	84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	018	1	1	04	01	H2230_018_1	6	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	195.00	195.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	018	1	1	04	01	H2230_018_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	018	2	1	04	01	H2230_018_2	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					0.00	0.00	0.00											5.00	5.00	5.00				0.00	0.00	0.00				8.00				8.00			0.27	0.00		0.17	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	018	2	1	04	01	H2230_018_2	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					6.00	12.00	18.00											11.00	17.00	17.00				6.00	12.00	12.00				12.00				12.00			0.40	0.20		0.37	0.20	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	018	2	1	04	01	H2230_018_2	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	89.00	89.00				42.00	84.00	84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	018	2	1	04	01	H2230_018_2	6	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	195.00	195.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	018	2	1	04	01	H2230_018_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	10	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	10	Generic	4	01	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	10	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					95.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	10	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	85.00	170.00	255.00																					245.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				892.39	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	9	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	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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	9	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	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				627.50	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	003	0	1	01	01	H2235_003_0	10	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	003	0	1	01	01	H2235_003_0	10	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	10	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					95.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	003	0	1	01	01	H2235_003_0	10	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	85.00	170.00	255.00																					245.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	003	0	1	01	01	H2235_003_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				696.61	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	13	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H2237	001	0	1	01	01	H2237_001_0	13	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												
H2237	001	0	1	01	01	H2237_001_0	13	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H2237	001	0	1	01	01	H2237_001_0	13	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	13	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	12	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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												
H2237	007	0	1	01	01	H2237_007_0	12	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												
H2237	007	0	1	01	01	H2237_007_0	12	Preferred Brand	4	11	1	2	3	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												
H2237	007	0	1	01	01	H2237_007_0	12	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	12	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	007	1	1	01	01	H2241_007_1	2	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	2	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	2	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	2	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	2	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	2	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	2	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	2	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	2	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	2	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	2	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	2	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	2	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	2	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	2	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	2	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	2	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	2	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	2	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	2	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	2	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	2	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	2	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	2	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	2	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	2	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	2	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	2	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	3	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	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	1	1	01	01	H2256_001_1	6	Vaccines	4	11	1	2	6	1	111		01			1	30	60	90				1	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, Vaccines												
H2256	001	2	1	01	01	H2256_001_2	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	2	1	01	01	H2256_001_2	6	Vaccines	4	11	1	2	6	1	111		01			1	30	60	90				1	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, Vaccines												
H2256	001	6	1	01	01	H2256_001_6	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	6	1	01	01	H2256_001_6	6	Vaccines	4	11	1	2	6	1	111		01			1	30	60	90				1	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, Vaccines												
H2256	015	1	1	01	01	H2256_015_1	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	1	1	01	01	H2256_015_1	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	1	1	01	01	H2256_015_1	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	1	1	01	01	H2256_015_1	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	1	1	01	01	H2256_015_1	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	1	1	01	01	H2256_015_1	7	Vaccines	4	11	1	2	6	1	111		01			1	30	60	90				1	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, Vaccines												
H2256	015	2	1	01	01	H2256_015_2	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	2	1	01	01	H2256_015_2	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	2	1	01	01	H2256_015_2	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	2	1	01	01	H2256_015_2	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	2	1	01	01	H2256_015_2	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	2	1	01	01	H2256_015_2	7	Vaccines	4	11	1	2	6	1	111		01			1	30	60	90				1	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, Vaccines												
H2256	015	6	1	01	01	H2256_015_6	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	6	1	01	01	H2256_015_6	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	6	1	01	01	H2256_015_6	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	6	1	01	01	H2256_015_6	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	6	1	01	01	H2256_015_6	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	6	1	01	01	H2256_015_6	7	Vaccines	4	11	1	2	6	1	111		01			1	30	60	90				1	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, Vaccines												
H2256	018	1	1	01	01	H2256_018_1	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	018	1	1	01	01	H2256_018_1	6	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	018	1	1	01	01	H2256_018_1	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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	018	1	1	01	01	H2256_018_1	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	018	1	1	01	01	H2256_018_1	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	1	1	01	01	H2256_018_1	6	Vaccines	4	11	1	2	6	1		111	01			1				30	60	90	1	2							30		31								0.00	0.00	0.00					0.00	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	018	7	1	01	01	H2256_018_7	6	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	018	7	1	01	01	H2256_018_7	6	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	018	7	1	01	01	H2256_018_7	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	018	7	1	01	01	H2256_018_7	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	018	7	1	01	01	H2256_018_7	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	7	1	01	01	H2256_018_7	6	Vaccines	4	11	1	2	6	1		111	01			1				30	60	90	1	2							30		31								0.00	0.00	0.00					0.00	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	018	8	1	01	01	H2256_018_8	6	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	018	8	1	01	01	H2256_018_8	6	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	018	8	1	01	01	H2256_018_8	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	018	8	1	01	01	H2256_018_8	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	018	8	1	01	01	H2256_018_8	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	8	1	01	01	H2256_018_8	6	Vaccines	4	11	1	2	6	1		111	01			1				30	60	90	1	2							30		31								0.00	0.00	0.00					0.00	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	1	1	01	01	H2256_026_1	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	1	1	01	01	H2256_026_1	6	Vaccines	4	11	1	2	6	1		111	01			1				30	60	90	1	2							30		31								0.00	0.00	0.00					0.00	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	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	2	1	01	01	H2256_026_2	6	Vaccines	4	11	1	2	6	1		111	01			1				30	60	90	1	2							30		31								0.00	0.00	0.00					0.00	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	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	3	1	01	01	H2256_026_3	6	Vaccines	4	11	1	2	6	1		111	01			1				30	60	90	1	2							30		31								0.00	0.00	0.00					0.00	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	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	028	0	1	01	01	H2256_028_0	6	Vaccines	4	11	1	2	6	1		111	01			1				30	60	90	1	2							30		31								0.00	0.00	0.00					0.00	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	8	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	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	033	0	1	01	01	H2256_033_0	8	Vaccines	4	11	1	2	6	1	111		01			1	30	60	90				1	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, Vaccines												
H2256	034	0	1	01	01	H2256_034_0	6	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	034	0	1	01	01	H2256_034_0	6	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	034	0	1	01	01	H2256_034_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	034	0	1	01	01	H2256_034_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	034	0	1	01	01	H2256_034_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	034	0	1	01	01	H2256_034_0	6	Vaccines	4	11	1	2	6	1		111	01			1				30	60	90	1	2							30		31								0.00	0.00	0.00					0.00	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	036	0	1	01	01	H2256_036_0	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	036	0	1	01	01	H2256_036_0	6	Vaccines	4	11	1	2	6	1		111	01			1				30	60	90	1	2							30		31								0.00	0.00	0.00					0.00	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	046	0	1	01	01	H2256_046_0	6	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	046	0	1	01	01	H2256_046_0	6	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	046	0	1	01	01	H2256_046_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	046	0	1	01	01	H2256_046_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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	046	0	1	01	01	H2256_046_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	046	0	1	01	01	H2256_046_0	6	Vaccines	4	11	1	2	6	1		111	01			1				30	60	90	1	2							30		31								0.00	0.00	0.00					0.00	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	5	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											5.00	5.00	5.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	15.00	15.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	89.00	89.00				42.00	84.00	84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	195.00	195.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	022	1	1	01	01	H2261_022_1	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					0.00	0.00	0.00											5.00	5.00	5.00				0.00	0.00	0.00				8.00				8.00			0.27	0.00		0.17	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	022	1	1	01	01	H2261_022_1	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					6.00	12.00	18.00											11.00	17.00	17.00				6.00	12.00	12.00				12.00				12.00			0.40	0.20		0.37	0.20	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	022	1	1	01	01	H2261_022_1	6	Preferred Brand	4	11	1	2	3	1		111	01		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	89.00	89.00				42.00	84.00	84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	022	1	1	01	01	H2261_022_1	6	Non-Preferred Brand	4	11	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	195.00	195.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	022	1	1	01	01	H2261_022_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	022	2	1	01	01	H2261_022_2	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					0.00	0.00	0.00											5.00	5.00	5.00				0.00	0.00	0.00				8.00				8.00			0.27	0.00		0.17	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	022	2	1	01	01	H2261_022_2	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					6.00	12.00	18.00											11.00	17.00	17.00				6.00	12.00	12.00				12.00				12.00			0.40	0.20		0.37	0.20	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	022	2	1	01	01	H2261_022_2	6	Preferred Brand	4	11	1	2	3	1		111	01		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	89.00	89.00				42.00	84.00	84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	022	2	1	01	01	H2261_022_2	6	Non-Preferred Brand	4	11	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	195.00	195.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	022	2	1	01	01	H2261_022_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											5.00	5.00	5.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	15.00	15.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	89.00	89.00				42.00	84.00	84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	6	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	195.00	195.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											5.00	5.00	5.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	15.00	15.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	89.00	89.00				42.00	84.00	84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	6	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	195.00	195.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	024	0	1	01	01	H2261_024_0	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					0.00	0.00	0.00											5.00	5.00	5.00				0.00	0.00	0.00				8.00				8.00			0.27	0.00		0.17	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	024	0	1	01	01	H2261_024_0	6	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					8.00	16.00	24.00											13.00	21.00	21.00				8.00	16.00	16.00				20.00				20.00			0.67	0.27		0.43	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	024	0	1	01	01	H2261_024_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	89.00	89.00				42.00	84.00	84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	024	0	1	01	01	H2261_024_0	6	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	195.00	195.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	024	0	1	01	01	H2261_024_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2288	001	0	1	01	01	H2288_001_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H2288	001	0	1	01	01	H2288_001_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				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												
H2288	001	0	1	01	01	H2288_001_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47.00		141.00																					94																47.00				47		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	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100.00		300.00																					200																100				100		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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				607.25	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	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0.00		0.00																					0																0				0		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	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H2288	002	0	1	01	01	H2288_002_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H2288	002	0	1	01	01	H2288_002_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	20		60																					40																20				20		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	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		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	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				609.67	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	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H2288	003	0	1	01	01	H2288_003_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	003	0	1	01	01	H2288_003_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H2288	003	0	1	01	01	H2288_003_0	5	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				7.89	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	003	0	1	01	01	H2288_003_0	5	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				94.87	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	003	0	1	01	01	H2288_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				50.28	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	003	0	1	01	01	H2288_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				590.88	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	003	0	1	01	01	H2288_003_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	003	0	1	01	01	H2288_003_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H2288	009	0	1	01	01	H2288_009_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H2288	009	0	1	01	01	H2288_009_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	12		36																					24																12				12		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	009	0	1	01	01	H2288_009_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		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	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	90		270																					180																90				90		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	009	0	1	01	01	H2288_009_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				425.97	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	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H2288	010	0	1	01	01	H2288_010_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					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	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H2288	010	0	1	01	01	H2288_010_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H2288	010	0	1	01	01	H2288_010_0	5	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				106.19	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	010	0	1	01	01	H2288_010_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				67.60	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	010	0	1	01	01	H2288_010_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				660.26	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	010	0	1	01	01	H2288_010_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					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	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H2292	003	0	1	04	01	H2292_003_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	003	0	1	04	01	H2292_003_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	003	0	1	04	01	H2292_003_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2292	003	0	1	04	01	H2292_003_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	003	0	1	04	01	H2292_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	003	0	1	04	01	H2292_003_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				298.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	1	1	02	01	H2320_022_1	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	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												
H2320	022	1	1	02	01	H2320_022_1	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	1	1	02	01	H2320_022_1	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	1	1	02	01	H2320_022_1	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.47	50	50	50				48.44	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	1	1	02	01	H2320_022_1	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	2	1	02	01	H2320_022_2	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	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												
H2320	022	2	1	02	01	H2320_022_2	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	2	1	02	01	H2320_022_2	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	2	1	02	01	H2320_022_2	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.47	50	50	50				48.44	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	2	1	02	01	H2320_022_2	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	3	1	02	01	H2320_022_3	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	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												
H2320	022	3	1	02	01	H2320_022_3	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	3	1	02	01	H2320_022_3	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	3	1	02	01	H2320_022_3	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.47	50	50	50				48.44	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	3	1	02	01	H2320_022_3	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	4	1	02	01	H2320_022_4	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	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												
H2320	022	4	1	02	01	H2320_022_4	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	4	1	02	01	H2320_022_4	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	4	1	02	01	H2320_022_4	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.47	50	50	50				48.44	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	4	1	02	01	H2320_022_4	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	5	1	02	01	H2320_022_5	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	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												
H2320	022	5	1	02	01	H2320_022_5	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	5	1	02	01	H2320_022_5	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	5	1	02	01	H2320_022_5	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.47	50	50	50				48.44	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	5	1	02	01	H2320_022_5	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	1	1	02	01	H2320_028_1	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	1	1	02	01	H2320_028_1	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	24.00											13.00	26.00	39.00				8.00	16.00	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												
H2320	028	1	1	02	01	H2320_028_1	9	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											43.00	86.00	129.00				38.00	76.00	95.00				43.00				43.00			1.43	1.27		1.43	1.27	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	1	1	02	01	H2320_028_1	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											37.08	45	45	45				48.52	45	45	45										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	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	2	1	02	01	H2320_028_2	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	2	1	02	01	H2320_028_2	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	24.00											13.00	26.00	39.00				8.00	16.00	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												
H2320	028	2	1	02	01	H2320_028_2	9	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											43.00	86.00	129.00				38.00	76.00	95.00				43.00				43.00			1.43	1.27		1.43	1.27	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	2	1	02	01	H2320_028_2	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											37.08	45	45	45				48.52	45	45	45										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	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	3	1	02	01	H2320_028_3	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	3	1	02	01	H2320_028_3	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	24.00											13.00	26.00	39.00				8.00	16.00	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												
H2320	028	3	1	02	01	H2320_028_3	9	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											43.00	86.00	129.00				38.00	76.00	95.00				43.00				43.00			1.43	1.27		1.43	1.27	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	3	1	02	01	H2320_028_3	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											37.08	45	45	45				48.52	45	45	45										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	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	4	1	02	01	H2320_028_4	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	4	1	02	01	H2320_028_4	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	24.00											13.00	26.00	39.00				8.00	16.00	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												
H2320	028	4	1	02	01	H2320_028_4	9	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											43.00	86.00	129.00				38.00	76.00	95.00				43.00				43.00			1.43	1.27		1.43	1.27	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	4	1	02	01	H2320_028_4	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											37.08	45	45	45				48.52	45	45	45										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	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	5	1	02	01	H2320_028_5	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	5	1	02	01	H2320_028_5	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	24.00											13.00	26.00	39.00				8.00	16.00	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												
H2320	028	5	1	02	01	H2320_028_5	9	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											43.00	86.00	129.00				38.00	76.00	95.00				43.00				43.00			1.43	1.27		1.43	1.27	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	5	1	02	01	H2320_028_5	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											37.08	45	45	45				48.52	45	45	45										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	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	1	1	02	01	H2320_029_1	11	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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												
H2320	029	1	1	02	01	H2320_029_1	11	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	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												
H2320	029	1	1	02	01	H2320_029_1	11	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	1	1	02	01	H2320_029_1	11	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.98	50	50	50				70.22	50	50	50										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	11	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			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	2	1	02	01	H2320_029_2	11	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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												
H2320	029	2	1	02	01	H2320_029_2	11	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	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												
H2320	029	2	1	02	01	H2320_029_2	11	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	2	1	02	01	H2320_029_2	11	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.98	50	50	50				70.22	50	50	50										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	11	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			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	3	1	02	01	H2320_029_3	11	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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												
H2320	029	3	1	02	01	H2320_029_3	11	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	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												
H2320	029	3	1	02	01	H2320_029_3	11	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	3	1	02	01	H2320_029_3	11	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.98	50	50	50				70.22	50	50	50										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	11	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			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	4	1	02	01	H2320_029_4	11	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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												
H2320	029	4	1	02	01	H2320_029_4	11	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	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												
H2320	029	4	1	02	01	H2320_029_4	11	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	4	1	02	01	H2320_029_4	11	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.98	50	50	50				70.22	50	50	50										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	11	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			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	5	1	02	01	H2320_029_5	11	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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												
H2320	029	5	1	02	01	H2320_029_5	11	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	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												
H2320	029	5	1	02	01	H2320_029_5	11	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	5	1	02	01	H2320_029_5	11	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.98	50	50	50				70.22	50	50	50										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	11	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			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	7	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	21.00					0.00	0.00	0.00											7.00	14.00	21.00				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	7	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											69.78	50	50	50				67.23	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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	004	0	1	04	01	H2322_004_0	7	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	004	0	1	04	01	H2322_004_0	7	Select Care Drugs	4	11	1	2	6	3		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2322	008	0	1	04	01	H2322_008_0	7	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	21.00					0.00	0.00	0.00											7.00	14.00	21.00				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	7	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											63.70	50	50	50				64.99	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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	008	0	1	04	01	H2322_008_0	7	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	7	Select Care Drugs	4	11	1	2	6	3		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2322	011	0	1	04	01	H2322_011_0	7	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	21.00					0.00	0.00	0.00											7.00	14.00	21.00				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	7	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											71.84	50	50	50				64.59	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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	011	0	1	04	01	H2322_011_0	7	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	7	Select Care Drugs	4	11	1	2	6	3		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2322	012	0	1	04	01	H2322_012_0	7	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	21.00					0.00	0.00	0.00											7.00	14.00	21.00				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	7	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											67.21	50	50	50				68.17	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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	012	0	1	04	01	H2322_012_0	7	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	7	Select Care Drugs	4	11	1	2	6	3		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2334	003	0	1	04	01	H2334_003_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								5.00	10.00	5.00					0.00	0.00	0.00											5.00	10.00	5.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	003	0	1	04	01	H2334_003_0	7	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	42.50					12.00	24.00	30.00											17.00	34.00	42.50				12.00	24.00	30.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	003	0	1	04	01	H2334_003_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	003	0	1	04	01	H2334_003_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	250.00					95.00	190.00	237.50											100.00	200.00	250.00				95.00	190.00	237.50				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	003	0	1	04	01	H2334_003_0	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											834.75	29	29	29				834.75	29	29	29										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	7	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	5.00					0.00	0.00	0.00											5.00	10.00	5.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	005	0	1	04	01	H2334_005_0	7	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	42.50					12.00	24.00	30.00											17.00	34.00	42.50				12.00	24.00	30.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	005	0	1	04	01	H2334_005_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	005	0	1	04	01	H2334_005_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	250.00					95.00	190.00	237.50											100.00	200.00	250.00				95.00	190.00	237.50				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	005	0	1	04	01	H2334_005_0	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											862.06	29	29	29				862.06	29	29	29										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	7	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	18.00					0.00	0.00	0.00											6.00	12.00	18.00				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	7	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											61.86	50	50	50				65.06	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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	015	0	1	01	01	H2354_015_0	7	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	015	0	1	01	01	H2354_015_0	7	Select Care Drugs	4	11	1	2	6	3		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2354	018	0	1	01	01	H2354_018_0	7	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	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				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	7	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											47.87	50	50	50				48.29	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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	018	0	1	01	01	H2354_018_0	7	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	7	Select Care Drugs	4	11	1	2	6	3		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2354	021	0	1	02	01	H2354_021_0	7	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	18.00					0.00	0.00	0.00											6.00	12.00	18.00				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	7	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											67.11	50	50	50				57.59	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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	021	0	1	02	01	H2354_021_0	7	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	7	Select Care Drugs	4	11	1	2	6	3		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2354	022	0	1	02	01	H2354_022_0	7	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	18.00					0.00	0.00	0.00											6.00	12.00	18.00				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	7	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											70.83	50	50	50				64.33	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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	022	0	1	02	01	H2354_022_0	7	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	7	Select Care Drugs	4	11	1	2	6	3		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2354	024	0	1	01	01	H2354_024_0	7	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	18.00					0.00	0.00	0.00											6.00	12.00	18.00				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	7	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											70.41	50	50	50				72.48	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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	024	0	1	01	01	H2354_024_0	7	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	7	Select Care Drugs	4	11	1	2	6	3		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2354	025	0	1	01	01	H2354_025_0	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				0.00			0.50	0.00		0.50	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	025	0	1	01	01	H2354_025_0	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				0.00			0.67	0.00		0.67	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	025	0	1	01	01	H2354_025_0	9	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	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, Select Care Drugs												
H2354	025	0	1	01	01	H2354_025_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					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	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	025	0	1	01	01	H2354_025_0	9	Specialty Tier	4	11	1	1	5	1		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												
H2354	025	0	1	01	01	H2354_025_0	9	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	025	0	1	01	01	H2354_025_0	9	Select Care Drugs	4	11	1	2	6	3		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2354	026	0	1	01	01	H2354_026_0	7	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	18.00					0.00	0.00	0.00											6.00	12.00	18.00				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	7	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	18.00					0.00	0.00	0.00											6.00	12.00	18.00				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	7	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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	7	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	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											59.11	50	50	50				59.64	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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	026	0	1	01	01	H2354_026_0	7	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	7	Select Care Drugs	4	11	1	2	6	3		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2354	027	0	1	01	01	H2354_027_0	7	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	18.00					0.00	0.00	0.00											6.00	12.00	18.00				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	7	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	18.00					0.00	0.00	0.00											6.00	12.00	18.00				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	7	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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	7	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	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											74.94	50	50	50				67.51	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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	027	0	1	01	01	H2354_027_0	7	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	7	Select Care Drugs	4	11	1	2	6	3		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2392	002	0	1	01	01	H2392_002_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	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	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			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												
H2392	002	0	1	01	01	H2392_002_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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												
H2392	002	0	1	01	01	H2392_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	98.00	196.00	294.00																			98.00	196.00	294.00																	98.00			98.00		3.27			3.27			3.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2392	002	0	1	01	01	H2392_002_0	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31					33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	4	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		
H2406	008	0	1	04	01	H2406_008_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	008	0	1	04	01	H2406_008_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				429.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	3	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		
H2406	009	0	1	04	01	H2406_009_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	009	0	1	04	01	H2406_009_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				228.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	3	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		
H2406	010	0	1	04	01	H2406_010_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	010	0	1	04	01	H2406_010_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	3	Specialty Tier	4	11	1	1	5	1	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												
H2406	011	0	1	04	01	H2406_011_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	3	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		
H2406	011	0	1	04	01	H2406_011_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	011	0	1	04	01	H2406_011_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				314.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	3	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		
H2406	012	0	1	04	01	H2406_012_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	012	0	1	04	01	H2406_012_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				325.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	3	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		
H2406	013	0	1	04	01	H2406_013_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	013	0	1	04	01	H2406_013_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				334.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	3	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		
H2406	014	0	1	04	01	H2406_014_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	014	0	1	04	01	H2406_014_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				396.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	3	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		
H2406	015	0	1	04	01	H2406_015_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	015	0	1	04	01	H2406_015_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	3	Specialty Tier	4	11	1	1	5	1	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												
H2406	016	0	1	04	01	H2406_016_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	3	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		
H2406	016	0	1	04	01	H2406_016_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	016	0	1	04	01	H2406_016_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	3	Specialty Tier	4	11	1	1	5	1	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												
H2406	017	0	1	04	01	H2406_017_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	3	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		
H2406	017	0	1	04	01	H2406_017_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	017	0	1	04	01	H2406_017_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				319.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2406	018	0	1	04	01	H2406_018_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	018	0	1	04	01	H2406_018_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				379.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	3	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		
H2406	019	0	1	04	01	H2406_019_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	019	0	1	04	01	H2406_019_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				331.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	4.00				10.00				2.00			0.33	0.07		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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	16.00				20.00				8.00			0.67	0.27		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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	70.00				47.00				35.00			1.57	1.17		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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											80.67	50	50	50				65.39	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	4.00				10.00				2.00			0.33	0.07		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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	16.00				20.00				8.00			0.67	0.27		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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	70.00				47.00				35.00			1.57	1.17		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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											67.19	50	50	50				73.88	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							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		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											10.00	20.00	30.00				2.00	4.00	4.00				10.00				2.00			0.33	0.07		0.33	0.07	0.06	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		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				10.00			0.67	0.33		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		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					38.00	76.00	114.00											47.00	94.00	141.00				38.00	76.00	76.00				47.00				38.00			1.57	1.27		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		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.68	50	50	50				82.58	50	50	50										50	50	50				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			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				10.00			0.67	0.33		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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	70.00				47.00				35.00			1.57	1.17		1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.59	46	46	46				99.30	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_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												
H2450	017	0	1	18	06	H2450_017_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				10.00			0.67	0.33		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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					33.00	66.00	99.00											47.00	94.00	141.00				33.00	66.00	66.00				47.00				33.00			1.57	1.10		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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.08	46	46	46				97.76	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_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												
H2450	035	0	1	18	06	H2450_035_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	035	0	1	18	06	H2450_035_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				10.00			0.67	0.33		0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	035	0	1	18	06	H2450_035_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	70.00				47.00				35.00			1.57	1.17		1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	035	0	1	18	06	H2450_035_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											105.62	46	46	46				95.64	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	035	0	1	18	06	H2450_035_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												
H2450	037	0	1	18	06	H2450_037_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	037	0	1	18	06	H2450_037_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					7.00	14.00	21.00											20.00	40.00	60.00				7.00	14.00	14.00				20.00				7.00			0.67	0.23		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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					28.00	56.00	84.00											47.00	94.00	141.00				28.00	56.00	56.00				47.00				28.00			1.57	0.93		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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.46	46	46	46				96.07	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	037	0	1	18	06	H2450_037_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												
H2450	039	0	1	18	06	H2450_039_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	4.00				10.00				2.00			0.33	0.07		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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				10.00			0.67	0.33		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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				40.00			1.57	1.33		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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.52	46	46	46				102.75	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	039	0	1	18	06	H2450_039_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	041	0	1	18	06	H2450_041_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	041	0	1	18	06	H2450_041_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				10.00			0.67	0.33		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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				40.00			1.57	1.33		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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											100.33	46	46	46				92.25	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	041	0	1	18	06	H2450_041_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	049	0	1	18	06	H2450_049_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				15.00			0.67	0.50		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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
H2450	049	0	1	18	06	H2450_049_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											100.01	46	46	46				99.17	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	049	0	1	18	06	H2450_049_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												
H2459	020	0	1	02	01	H2459_020_0	4	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								12.00	24.00	36.00					3.00	6.00	9.00											12.00	24.00	36.00				3.00	6.00	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	4	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	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												
H2459	020	0	1	02	01	H2459_020_0	4	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											115.00	25	25	25				78.00	17	17	17										25	25	25				17	17	17				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	020	0	1	02	01	H2459_020_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											70.00	50	50	50				70.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	020	0	1	02	01	H2459_020_0	4	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2272.00	25	25	25				2272.00	25	25	25										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	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					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	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					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	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								17.00	34.00	51.00					7.00	14.00	21.00											17.00	34.00	51.00				7.00	14.00	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	5	Generic	4	11	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								17.00	34.00	51.00					7.00	14.00	21.00											17.00	34.00	51.00				7.00	14.00	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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											77.00	50	50	50				77.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	1	1	02	01	H2459_021_1	5	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2877.00	29	29	29				2877.00	29	29	29										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	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					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	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					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	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								17.00	34.00	51.00					7.00	14.00	21.00											17.00	34.00	51.00				7.00	14.00	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	5	Generic	4	11	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								17.00	34.00	51.00					7.00	14.00	21.00											17.00	34.00	51.00				7.00	14.00	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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											77.00	50	50	50				77.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	2	1	02	01	H2459_021_2	5	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2877.00	29	29	29				2877.00	29	29	29										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	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					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	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					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	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								17.00	34.00	51.00					7.00	14.00	21.00											17.00	34.00	51.00				7.00	14.00	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	Generic	4	11	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								17.00	34.00	51.00					7.00	14.00	21.00											17.00	34.00	51.00				7.00	14.00	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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											77.00	50	50	50				77.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	3	1	02	01	H2459_021_3	5	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2877.00	29	29	29				2877.00	29	29	29										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	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								12.00	24.00	36.00					2.00	4.00	6.00											12.00	24.00	36.00				2.00	4.00	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	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	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												
H2459	023	1	1	02	01	H2459_023_1	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	141.00					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	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	1	1	02	01	H2459_023_1	7	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											60.00	50	50	50				60.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	1	1	02	01	H2459_023_1	7	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2329.00	25	25	25				2329.00	25	25	25										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	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								12.00	24.00	36.00					2.00	4.00	6.00											12.00	24.00	36.00				2.00	4.00	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	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	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												
H2459	023	2	1	02	01	H2459_023_2	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	141.00					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	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	2	1	02	01	H2459_023_2	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											60.00	50	50	50				60.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	2	1	02	01	H2459_023_2	5	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2329.00	25	25	25				2329.00	25	25	25										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	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								12.00	24.00	36.00					3.00	6.00	9.00											12.00	24.00	36.00				3.00	6.00	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	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	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												
H2459	024	0	1	02	01	H2459_024_0	5	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											108.00	25	25	25				73.00	17	17	17										25	25	25				17	17	17				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	024	0	1	02	01	H2459_024_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											68.00	50	50	50				68.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	024	0	1	02	01	H2459_024_0	5	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											1674.00	25	25	25				1674.00	25	25	25										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	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								12.00	24.00	36.00					0.00	0.00	0.00											12.00	24.00	36.00				0.00	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	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	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												
H2459	026	1	1	02	01	H2459_026_1	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	141.00					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	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	1	1	02	01	H2459_026_1	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											65.00	50	50	50				65.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	1	1	02	01	H2459_026_1	5	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2376.00	28	28	28				2376.00	28	28	28										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	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								12.00	24.00	36.00					0.00	0.00	0.00											12.00	24.00	36.00				0.00	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	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	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												
H2459	026	3	1	02	01	H2459_026_3	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	141.00					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	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	3	1	02	01	H2459_026_3	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											65.00	50	50	50				65.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	3	1	02	01	H2459_026_3	5	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2376.00	28	28	28				2376.00	28	28	28										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	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								12.00	24.00	36.00					0.00	0.00	0.00											12.00	24.00	36.00				0.00	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	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	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												
H2459	026	4	1	02	01	H2459_026_4	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	141.00					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	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	4	1	02	01	H2459_026_4	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											65.00	50	50	50				65.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	4	1	02	01	H2459_026_4	5	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2376.00	28	28	28				2376.00	28	28	28										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	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								12.00	24.00	36.00					3.00	6.00	9.00											12.00	24.00	36.00				3.00	6.00	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	8	Generic	4	11	1	1	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											7.00	25	25	25				5.00	20	20	20										25	25	25				20	20	20				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	028	0	1	02	01	H2459_028_0	8	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											108.00	25	25	25				87.00	20	20	20										25	25	25				20	20	20				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	028	0	1	02	01	H2459_028_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											70.00	50	50	50				70.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	028	0	1	02	01	H2459_028_0	8	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											1779.00	25	25	25				1779.00	25	25	25										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	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								12.00	24.00	36.00					2.00	4.00	6.00											12.00	24.00	36.00				2.00	4.00	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	8	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	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												
H2459	029	0	1	02	01	H2459_029_0	8	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											119.00	25	25	25				81.00	17	17	17										25	25	25				17	17	17				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	029	0	1	02	01	H2459_029_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											60.00	50	50	50				60.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	029	0	1	02	01	H2459_029_0	8	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2329.00	25	25	25				2329.00	25	25	25										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	8	Preferred Generic	4	11	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	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												
H2459	031	0	1	01	01	H2459_031_0	8	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	13.00	26.00	39.00																			13.00	26.00	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	8	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	141.00																			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												
H2459	031	0	1	01	01	H2459_031_0	8	Non-Preferred Drug	4	11	1	1	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				49.96	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	8	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				940.90	25	25	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	8	Preferred Generic	4	11	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	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												
H2459	032	0	1	01	01	H2459_032_0	8	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	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												
H2459	032	0	1	01	01	H2459_032_0	8	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	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												
H2459	032	0	1	01	01	H2459_032_0	8	Non-Preferred Drug	4	11	1	1	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				53.79	25	25	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	8	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				945.91	25	25	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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	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	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.48			0.48			0.48	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				56.77	25	25	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	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				90.66	50	50	50																		50	50	50															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								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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	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	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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				50.47	20	20	20																		20	20	20															20			20								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				92.65	45	45	45																		45	45	45															45			45								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								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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	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	9.00	18.00	18.00																			9.00	18.00	18.00																9.00				9.00		0.29			0.29			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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				50.47	20	20	20																		20	20	20															20			20								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				99.50	42	42	42																		42	42	42															42			42								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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	8	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	8	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	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	005	0	1	01	01	H2486_005_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	005	0	1	01	01	H2486_005_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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												
H2486	005	0	1	01	01	H2486_005_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	005	0	1	01	01	H2486_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	005	0	1	01	01	H2486_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	006	0	1	01	01	H2486_006_0	7	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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	006	0	1	01	01	H2486_006_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	007	0	1	01	01	H2486_007_0	8	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	8	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	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	008	0	1	01	01	H2486_008_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	008	0	1	01	01	H2486_008_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	3	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	004	0	1	01	01	H2491_004_0	3	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	12.00	24.00	36.00																									12.00	24.00	36.00				12.00	24.00	0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	004	0	1	01	01	H2491_004_0	3	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	004	0	1	01	01	H2491_004_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.99	41	41	41																								41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	004	0	1	01	01	H2491_004_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, Select Care Drugs												
H2491	004	0	1	01	01	H2491_004_0	3	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	006	0	1	01	01	H2491_006_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	006	0	1	01	01	H2491_006_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	11.00	22.00	33.00																									11.00	22.00	33.00				11.00	22.00	0.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	006	0	1	01	01	H2491_006_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	006	0	1	01	01	H2491_006_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.87	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	006	0	1	01	01	H2491_006_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	006	0	1	01	01	H2491_006_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	007	0	1	01	01	H2491_007_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	007	0	1	01	01	H2491_007_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	007	0	1	01	01	H2491_007_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	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, Select Care Drugs												
H2491	007	0	1	01	01	H2491_007_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.07	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	007	0	1	01	01	H2491_007_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	007	0	1	01	01	H2491_007_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	007	0	1	01	01	H2491_007_0	4	Select Care Drugs	4	11	1	2	6	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2491	008	0	1	01	01	H2491_008_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	008	0	1	01	01	H2491_008_0	5	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	15.00				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												
H2491	008	0	1	01	01	H2491_008_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	36.00	72.00	108.00																									36.00	72.00	108.00				36.00	72.00	72.00				36.00				36.00		1.2				1.2	1.2	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	008	0	1	01	01	H2491_008_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				91.90	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	008	0	1	01	01	H2491_008_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	008	0	1	01	01	H2491_008_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	009	0	1	01	01	H2491_009_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	009	0	1	01	01	H2491_009_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	009	0	1	01	01	H2491_009_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H2491	009	0	1	01	01	H2491_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H2491	009	0	1	01	01	H2491_009_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	009	0	1	01	01	H2491_009_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	010	0	1	01	01	H2491_010_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	010	0	1	01	01	H2491_010_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	17.00	34.00	51.00																									17.00	34.00	51.00				17.00	34.00	0.00				17.00				17.00		0.57				0.57	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	010	0	1	01	01	H2491_010_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	010	0	1	01	01	H2491_010_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				92.19	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	010	0	1	01	01	H2491_010_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	010	0	1	01	01	H2491_010_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	011	0	1	01	01	H2491_011_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	011	0	1	01	01	H2491_011_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	011	0	1	01	01	H2491_011_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	011	0	1	01	01	H2491_011_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.48	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	011	0	1	01	01	H2491_011_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	011	0	1	01	01	H2491_011_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	012	0	1	01	01	H2491_012_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	012	0	1	01	01	H2491_012_0	4	Generic	4	11	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	12.00	0.00				6.00				6.00		0.2				0.2	0.2	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	012	0	1	01	01	H2491_012_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	012	0	1	01	01	H2491_012_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				93.65	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	012	0	1	01	01	H2491_012_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	012	0	1	01	01	H2491_012_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	013	0	1	01	01	H2491_013_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	013	0	1	01	01	H2491_013_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	013	0	1	01	01	H2491_013_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H2491	013	0	1	01	01	H2491_013_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				93.93	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	013	0	1	01	01	H2491_013_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	013	0	1	01	01	H2491_013_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	014	0	1	01	01	H2491_014_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	014	0	1	01	01	H2491_014_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	014	0	1	01	01	H2491_014_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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, Select Care Drugs												
H2491	014	0	1	01	01	H2491_014_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.93	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	014	0	1	01	01	H2491_014_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	014	0	1	01	01	H2491_014_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	014	0	1	01	01	H2491_014_0	4	Select Care Drugs	4	11	1	2	6	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2491	015	0	1	01	01	H2491_015_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	015	0	1	01	01	H2491_015_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	015	0	1	01	01	H2491_015_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H2491	015	0	1	01	01	H2491_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H2491	015	0	1	01	01	H2491_015_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	015	0	1	01	01	H2491_015_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	016	0	1	01	01	H2491_016_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	016	0	1	01	01	H2491_016_0	4	Preferred Generic	4	11	3	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2491	016	0	1	01	01	H2491_016_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	016	0	1	01	01	H2491_016_0	4	Generic	4	11	1	2	2	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2491	016	0	1	01	01	H2491_016_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	35.00	70.00	105.00																									35.00	70.00	105.00				35.00	70.00	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												
H2491	016	0	1	01	01	H2491_016_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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, Select Care Drugs												
H2491	016	0	1	01	01	H2491_016_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	016	0	1	01	01	H2491_016_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	016	0	1	01	01	H2491_016_0	4	Select Care Drugs	4	11	1	2	6	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2491	017	0	1	01	01	H2491_017_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	017	0	1	01	01	H2491_017_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	017	0	1	01	01	H2491_017_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H2491	017	0	1	01	01	H2491_017_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.15	45	45	45																								45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	017	0	1	01	01	H2491_017_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	017	0	1	01	01	H2491_017_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	017	0	1	01	01	H2491_017_0	4	Select Care Drugs	4	11	1	2	6	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2506	001	0	1	48	05	H2506_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			
H2506	001	0	1	48	05	H2506_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			
H2506	001	0	1	48	05	H2506_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			
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	3.95	0.00	3.95	0.00	3.95	0.00	3.95			
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	9.85	0.00	9.85	0.00	9.85	0.00	9.85			
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	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	2	2			90				30		31								5.00		12.50					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	1	1	01	01	H2563_005_1	11	Generic	4	01	3	2	2	1		110	01	100		1				30		90	2	2			90				30		31								15.00		37.50					8.00		20.00							0.00																15.00				8.00			0.50	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	1	1	01	01	H2563_005_1	11	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	2	2			90				30		31								45.00		112.50					40.00		100.00							80.00																45.00				40.00			1.50	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	1	1	01	01	H2563_005_1	11	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	2	2			90				30		31								95.00		285.00					90.00		270.00							270.00																95.00				90.00			3.17	3.00				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	1	1	01	01	H2563_005_1	11	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											760.53	30						724.69	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	2	1	01	01	H2563_005_2	11	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	2	2			90				30		31								5.00		12.50					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	2	1	01	01	H2563_005_2	11	Generic	4	01	3	2	2	1		110	01	100		1				30		90	2	2			90				30		31								15.00		37.50					8.00		20.00							0.00																15.00				8.00			0.50	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	2	1	01	01	H2563_005_2	11	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	2	2			90				30		31								45.00		112.50					40.00		100.00							80.00																45.00				40.00			1.50	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	2	1	01	01	H2563_005_2	11	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	2	2			90				30		31								95.00		285.00					90.00		270.00							270.00																95.00				90.00			3.17	3.00				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	2	1	01	01	H2563_005_2	11	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											760.53	30						724.69	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	008	0	1	01	01	H2563_008_0	11	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	2	2			90				30		31								5.00		12.50					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	008	0	1	01	01	H2563_008_0	11	Generic	4	01	3	2	2	1		110	01	100		1				30		90	2	2			90				30		31								15.00		37.50					10.00		25.00							0.00																15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	008	0	1	01	01	H2563_008_0	11	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	2	2			90				30		31								47.00		117.50					42.00		105.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	008	0	1	01	01	H2563_008_0	11	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	2	2			90				30		31								100.00		300.00					95.00		285.00							285.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	008	0	1	01	01	H2563_008_0	11	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											864.76	30						859.20	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	009	0	1	01	01	H2563_009_0	11	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	2	2			90				30		31								5.00		12.50					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	009	0	1	01	01	H2563_009_0	11	Generic	4	01	3	2	2	1		110	01	100		1				30		90	2	2			90				30		31								15.00		37.50					10.00		25.00							0.00																15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	009	0	1	01	01	H2563_009_0	11	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	2	2			90				30		31								47.00		117.50					42.00		105.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	009	0	1	01	01	H2563_009_0	11	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	2	2			90				30		31								100.00		300.00					95.00		285.00							285.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	009	0	1	01	01	H2563_009_0	11	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											928.02	30						896.18	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	012	0	1	01	01	H2563_012_0	10	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	2	2			90				30		31								5.00		12.50					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	012	0	1	01	01	H2563_012_0	10	Generic	4	01	3	2	2	1		110	01	100		1				30		90	2	2			90				30		31								15.00		37.50					8.00		20.00							0.00																15.00				8.00			0.50	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	012	0	1	01	01	H2563_012_0	10	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	2	2			90				30		31								45.00		112.50					40.00		100.00							80.00																45.00				40.00			1.50	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	012	0	1	01	01	H2563_012_0	10	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	2	2			90				30		31								95.00		285.00					90.00		270.00							270.00																95.00				90.00			3.17	3.00				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	012	0	1	01	01	H2563_012_0	10	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											899.77	30						893.84	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	013	0	1	01	01	H2563_013_0	10	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	2	2			90				30		31								5.00		12.50					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	013	0	1	01	01	H2563_013_0	10	Generic	4	01	3	2	2	1		110	01	100		1				30		90	2	2			90				30		31								15.00		37.50					8.00		20.00							0.00																15.00				8.00			0.50	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	013	0	1	01	01	H2563_013_0	10	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	2	2			90				30		31								45.00		112.50					40.00		100.00							80.00																45.00				40.00			1.50	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	013	0	1	01	01	H2563_013_0	10	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	2	2			90				30		31								95.00		285.00					90.00		270.00							270.00																95.00				90.00			3.17	3.00				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	013	0	1	01	01	H2563_013_0	10	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											912.06	30						906.12	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	015	0	1	01	01	H2563_015_0	11	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	2	2			90				30		31								5.00		12.50					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	015	0	1	01	01	H2563_015_0	11	Generic	4	01	3	2	2	1		110	01	100		1				30		90	2	2			90				30		31								15.00		37.50					10.00		25.00							0.00																15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	015	0	1	01	01	H2563_015_0	11	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	2	2			90				30		31								47.00		117.50					42.00		105.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	015	0	1	01	01	H2563_015_0	11	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	2	2			90				30		31								100.00		300.00					95.00		285.00							285.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	015	0	1	01	01	H2563_015_0	11	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											855.09	30						849.59	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	016	0	1	01	01	H2563_016_0	11	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	2	2			90				30		31								5.00		12.50					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	016	0	1	01	01	H2563_016_0	11	Generic	4	01	3	2	2	1		110	01	100		1				30		90	2	2			90				30		31								15.00		37.50					10.00		25.00							0.00																15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	016	0	1	01	01	H2563_016_0	11	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	2	2			90				30		31								47.00		117.50					42.00		105.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	016	0	1	01	01	H2563_016_0	11	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	2	2			90				30		31								100.00		300.00					95.00		285.00							285.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	016	0	1	01	01	H2563_016_0	11	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											887.75	30						882.04	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	1	1	01	01	H2563_017_1	11	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	2	2			90				30		31								5.00		12.50					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	1	1	01	01	H2563_017_1	11	Generic	4	01	3	2	2	1		110	01	100		1				30		90	2	2			90				30		31								15.00		37.50					10.00		25.00							0.00																15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	1	1	01	01	H2563_017_1	11	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	2	2			90				30		31								47.00		117.50					42.00		105.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	1	1	01	01	H2563_017_1	11	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	2	2			90				30		31								100.00		300.00					95.00		285.00							285.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	1	1	01	01	H2563_017_1	11	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1026.19	30						847.54	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	2	1	01	01	H2563_017_2	11	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	2	2			90				30		31								5.00		12.50					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	2	1	01	01	H2563_017_2	11	Generic	4	01	3	2	2	1		110	01	100		1				30		90	2	2			90				30		31								15.00		37.50					10.00		25.00							0.00																15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	2	1	01	01	H2563_017_2	11	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	2	2			90				30		31								47.00		117.50					42.00		105.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	2	1	01	01	H2563_017_2	11	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	2	2			90				30		31								100.00		300.00					95.00		285.00							285.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	2	1	01	01	H2563_017_2	11	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1026.19	30						847.54	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	1	1	04	01	H2577_001_1	3	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												
H2577	001	1	1	04	01	H2577_001_1	3	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		
H2577	001	1	1	04	01	H2577_001_1	3	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												
H2577	001	1	1	04	01	H2577_001_1	3	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
H2577	001	1	1	04	01	H2577_001_1	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	1	1	04	01	H2577_001_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	1	1	04	01	H2577_001_1	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				412.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	2	1	04	01	H2577_001_2	3	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												
H2577	001	2	1	04	01	H2577_001_2	3	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		
H2577	001	2	1	04	01	H2577_001_2	3	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												
H2577	001	2	1	04	01	H2577_001_2	3	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
H2577	001	2	1	04	01	H2577_001_2	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	2	1	04	01	H2577_001_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	2	1	04	01	H2577_001_2	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				412.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	002	0	1	04	01	H2577_002_0	3	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	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		
H2577	002	0	1	04	01	H2577_002_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											699.00	33						447.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	1	1	04	01	H2577_003_1	3	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												
H2577	003	1	1	04	01	H2577_003_1	3	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		
H2577	003	1	1	04	01	H2577_003_1	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				243.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	2	1	04	01	H2577_003_2	3	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												
H2577	003	2	1	04	01	H2577_003_2	3	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		
H2577	003	2	1	04	01	H2577_003_2	3	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	3	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	2	1	04	01	H2577_003_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	2	1	04	01	H2577_003_2	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				243.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	004	0	1	04	01	H2577_004_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	004	0	1	04	01	H2577_004_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	004	0	1	04	01	H2577_004_0	3	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	004	0	1	04	01	H2577_004_0	3	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	004	0	1	04	01	H2577_004_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	004	0	1	04	01	H2577_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	004	0	1	04	01	H2577_004_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				335.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	005	0	1	04	01	H2577_005_0	3	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	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		
H2577	005	0	1	04	01	H2577_005_0	3	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												
H2577	005	0	1	04	01	H2577_005_0	3	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
H2577	005	0	1	04	01	H2577_005_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											430.00	31						284.00	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	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	006	0	1	04	01	H2577_006_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	006	0	1	04	01	H2577_006_0	3	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												
H2577	006	0	1	04	01	H2577_006_0	3	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
H2577	006	0	1	04	01	H2577_006_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	006	0	1	04	01	H2577_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	006	0	1	04	01	H2577_006_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				457.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	007	0	1	04	01	H2577_007_0	3	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	3	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		
H2577	007	0	1	04	01	H2577_007_0	3	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	3	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	3	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	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											559.00	33						530.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	008	0	1	04	01	H2577_008_0	3	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	3	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		
H2577	008	0	1	04	01	H2577_008_0	3	Generic	4	01	3	2	2	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												
H2577	008	0	1	04	01	H2577_008_0	3	Generic	4	01	3	2	2	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										2		2
H2577	008	0	1	04	01	H2577_008_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					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	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											404.00	33						445.00	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	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	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		
H2577	009	0	1	04	01	H2577_009_0	3	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												
H2577	009	0	1	04	01	H2577_009_0	3	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
H2577	009	0	1	04	01	H2577_009_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											387.00	29						295.00	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	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	011	0	1	04	01	H2577_011_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	011	0	1	04	01	H2577_011_0	3	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												
H2577	011	0	1	04	01	H2577_011_0	3	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
H2577	011	0	1	04	01	H2577_011_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	011	0	1	04	01	H2577_011_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	011	0	1	04	01	H2577_011_0	3	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												
H2577	013	0	1	04	01	H2577_013_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	013	0	1	04	01	H2577_013_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	013	0	1	04	01	H2577_013_0	3	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												
H2577	013	0	1	04	01	H2577_013_0	3	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
H2577	013	0	1	04	01	H2577_013_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	013	0	1	04	01	H2577_013_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	013	0	1	04	01	H2577_013_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				464.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	014	0	1	04	01	H2577_014_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	014	0	1	04	01	H2577_014_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	014	0	1	04	01	H2577_014_0	3	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												
H2577	014	0	1	04	01	H2577_014_0	3	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
H2577	014	0	1	04	01	H2577_014_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	014	0	1	04	01	H2577_014_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	014	0	1	04	01	H2577_014_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				436.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	016	0	1	04	01	H2577_016_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	016	0	1	04	01	H2577_016_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	016	0	1	04	01	H2577_016_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				261.00	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	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	017	0	1	04	01	H2577_017_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	017	0	1	04	01	H2577_017_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				327.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	018	0	1	04	01	H2577_018_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	018	0	1	04	01	H2577_018_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	018	0	1	04	01	H2577_018_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	018	0	1	04	01	H2577_018_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	018	0	1	04	01	H2577_018_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	018	0	1	04	01	H2577_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	018	0	1	04	01	H2577_018_0	3	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												
H2577	020	0	1	04	01	H2577_020_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	020	0	1	04	01	H2577_020_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	020	0	1	04	01	H2577_020_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	020	0	1	04	01	H2577_020_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	020	0	1	04	01	H2577_020_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	020	0	1	04	01	H2577_020_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	020	0	1	04	01	H2577_020_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				386.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	021	0	1	04	01	H2577_021_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	021	0	1	04	01	H2577_021_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				457.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	022	0	1	04	01	H2577_022_0	4	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												
H2577	022	0	1	04	01	H2577_022_0	4	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		
H2577	022	0	1	04	01	H2577_022_0	4	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												
H2577	022	0	1	04	01	H2577_022_0	4	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
H2577	022	0	1	04	01	H2577_022_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	022	0	1	04	01	H2577_022_0	4	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	022	0	1	04	01	H2577_022_0	4	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												
H2577	023	0	1	04	01	H2577_023_0	4	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												
H2577	023	0	1	04	01	H2577_023_0	4	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		
H2577	023	0	1	04	01	H2577_023_0	4	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												
H2577	023	0	1	04	01	H2577_023_0	4	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
H2577	023	0	1	04	01	H2577_023_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	023	0	1	04	01	H2577_023_0	4	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	023	0	1	04	01	H2577_023_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				395.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	026	0	1	04	01	H2577_026_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	026	0	1	04	01	H2577_026_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	026	0	1	04	01	H2577_026_0	3	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	026	0	1	04	01	H2577_026_0	3	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	026	0	1	04	01	H2577_026_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	026	0	1	04	01	H2577_026_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	026	0	1	04	01	H2577_026_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				402.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	027	0	1	04	01	H2577_027_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	027	0	1	04	01	H2577_027_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	027	0	1	04	01	H2577_027_0	3	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												
H2577	027	0	1	04	01	H2577_027_0	3	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
H2577	027	0	1	04	01	H2577_027_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	027	0	1	04	01	H2577_027_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	027	0	1	04	01	H2577_027_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				446.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	028	0	1	04	01	H2577_028_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	028	0	1	04	01	H2577_028_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	028	0	1	04	01	H2577_028_0	3	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	028	0	1	04	01	H2577_028_0	3	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	028	0	1	04	01	H2577_028_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	028	0	1	04	01	H2577_028_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	028	0	1	04	01	H2577_028_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				579.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	029	0	1	04	01	H2577_029_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	029	0	1	04	01	H2577_029_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	029	0	1	04	01	H2577_029_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	029	0	1	04	01	H2577_029_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	029	0	1	04	01	H2577_029_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	029	0	1	04	01	H2577_029_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	029	0	1	04	01	H2577_029_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				484.00	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	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												
H2582	004	0	1	01	01	H2582_004_0	3	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		
H2582	004	0	1	01	01	H2582_004_0	3	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												
H2582	004	0	1	01	01	H2582_004_0	3	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
H2582	004	0	1	01	01	H2582_004_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	004	0	1	01	01	H2582_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	004	0	1	01	01	H2582_004_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				547.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	005	0	1	01	01	H2582_005_0	3	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												
H2582	005	0	1	01	01	H2582_005_0	3	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		
H2582	005	0	1	01	01	H2582_005_0	3	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												
H2582	005	0	1	01	01	H2582_005_0	3	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
H2582	005	0	1	01	01	H2582_005_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	005	0	1	01	01	H2582_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	005	0	1	01	01	H2582_005_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				511.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2593	001	0	1	01	01	H2593_001_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	7	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	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	001	0	1	01	01	H2593_001_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	7	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	7	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	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	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	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	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	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	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	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	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	6	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	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	005	0	1	01	01	H2593_005_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	6	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	6	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	6	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	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	006	0	1	01	01	H2593_006_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	6	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	6	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	6	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	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	013	0	1	01	01	H2593_013_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	6	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	6	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	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					0.00	0.00	0.00																15.50				15.50			0.52	0.35	0.00			0.46	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	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												
H2593	019	0	1	01	01	H2593_019_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	019	0	1	01	01	H2593_019_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	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	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	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	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	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	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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												
H2593	021	0	1	01	01	H2593_021_0	8	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												
H2593	021	0	1	01	01	H2593_021_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	021	0	1	01	01	H2593_021_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	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	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												
H2593	022	0	1	01	01	H2593_022_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					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	7	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					0.00	0.00	0.00																13.00				13.00			0.43	0.27	0.00			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	022	0	1	01	01	H2593_022_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	022	0	1	01	01	H2593_022_0	7	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	7	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	9	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	9	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					0.00	0.00	0.00																13.00				13.00			0.43	0.27	0.00			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	023	0	1	01	01	H2593_023_0	9	Preferred Brand	4	11	1	2	3	1		111	01	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	023	0	1	01	01	H2593_023_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	023	0	1	01	01	H2593_023_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	025	0	1	01	01	H2593_025_0	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	025	0	1	01	01	H2593_025_0	9	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	9	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					0.00	0.00	0.00																9.00				9.00			0.30	0.30	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	025	0	1	01	01	H2593_025_0	9	Preferred Brand	4	11	1	2	3	1		111	01	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	025	0	1	01	01	H2593_025_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	025	0	1	01	01	H2593_025_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	8	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					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	8	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	8	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	8	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	9	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	031	0	1	02	01	H2593_031_0	9	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					0.00	0.00	0.00																12.00				12.00			0.40	0.23	0.00			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	031	0	1	02	01	H2593_031_0	9	Preferred Brand	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	031	0	1	02	01	H2593_031_0	9	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	9	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	8	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					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												
H2593	032	0	1	01	01	H2593_032_0	8	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												
H2593	032	0	1	01	01	H2593_032_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	8	Select Care Drugs	4	01	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	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												
H2593	037	0	1	01	01	H2593_037_0	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	037	0	1	01	01	H2593_037_0	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	037	0	1	01	01	H2593_037_0	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	8	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	8	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	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	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	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	040	0	1	01	01	H2593_040_0	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	040	0	1	01	01	H2593_040_0	6	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	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	Specialty Tier	4	11	1	1	5	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	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	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	041	0	1	01	01	H2593_041_0	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	041	0	1	01	01	H2593_041_0	8	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	8	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	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	042	0	1	01	01	H2593_042_0	8	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	8	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	042	0	1	01	01	H2593_042_0	8	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	8	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	8	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	8	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	8	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	8	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	043	0	1	01	01	H2593_043_0	10	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					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, Select Care Drugs												
H2593	043	0	1	01	01	H2593_043_0	10	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	043	0	1	01	01	H2593_043_0	10	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	043	0	1	01	01	H2593_043_0	10	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	043	0	1	01	01	H2593_043_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	043	0	1	01	01	H2593_043_0	10	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	043	0	1	01	01	H2593_043_0	10	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		
H2610	005	0	1	01	01	H2610_005_0	5	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								4.00	8.00	12.00					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	5	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	5	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											697.44	33						697.44	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	5	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	6	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								4.00	8.00	12.00					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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											638.04	33						638.04	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	6	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	6	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	6	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							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	6	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	6	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					42.00	84.00	126.00							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	6	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								95.00	190.00	285.00					85.00	170.00	255.00							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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											637.25	33						637.25	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	6	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	4	Preferred Generic	4	01	1	2	1	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							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	015	0	1	01	01	H2610_015_0	4	Generic	4	01	3	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								10.00	20.00	30.00					5.00	10.00	15.00							12.50																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	015	0	1	01	01	H2610_015_0	4	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					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	015	0	1	01	01	H2610_015_0	4	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								100.00	200.00	300.00					95.00	190.00	285.00							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	015	0	1	01	01	H2610_015_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											613.40	33						613.40	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	4	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	016	0	1	01	01	H2610_016_0	4	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	4	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	4	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					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	4	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	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											701.24	33						701.24	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	4	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	017	0	1	01	01	H2610_017_0	10	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								5.00	10.00	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 Brand, Specialty Tier, Select Diabetic Drugs												
H2610	017	0	1	01	01	H2610_017_0	10	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	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, Select Diabetic Drugs												
H2610	017	0	1	01	01	H2610_017_0	10	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	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	017	0	1	01	01	H2610_017_0	10	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								100.00	200.00	300.00					95.00	190.00	285.00							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	017	0	1	01	01	H2610_017_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											527.87	25						527.87	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	017	0	1	01	01	H2610_017_0	10	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	15	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	15	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	15	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	15	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	15	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, Select Care Drugs												
H2624	001	0	1	01	01	H2624_001_0	15	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				982.45	31	31	31																		31	31	31																31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2624	001	0	1	01	01	H2624_001_0	15	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	15	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	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	002	0	1	01	01	H2663_002_0	4	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	002	0	1	01	01	H2663_002_0	4	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	002	0	1	01	01	H2663_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	002	0	1	01	01	H2663_002_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1225.83	33						485.83	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	005	0	1	01	01	H2663_005_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	005	0	1	01	01	H2663_005_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H2663	005	0	1	01	01	H2663_005_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	005	0	1	01	01	H2663_005_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1035.66	33						633.79	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											972.05	33						388.64	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1025.00	33						480.60	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	021	0	1	02	01	H2663_021_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	021	0	1	02	01	H2663_021_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H2663_021_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	021	0	1	02	01	H2663_021_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H2663_021_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	021	0	1	02	01	H2663_021_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	021	0	1	02	01	H2663_021_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1164.34	33						547.79	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	023	0	1	02	01	H2663_023_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	023	0	1	02	01	H2663_023_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	023	0	1	02	01	H2663_023_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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										1		
H2663	023	0	1	02	01	H2663_023_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	023	0	1	02	01	H2663_023_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	023	0	1	02	01	H2663_023_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											772.00	33						568.39	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	026	0	1	01	01	H2663_026_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	026	0	1	01	01	H2663_026_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	026	0	1	01	01	H2663_026_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	026	0	1	01	01	H2663_026_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	026	0	1	01	01	H2663_026_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	026	0	1	01	01	H2663_026_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1016.23	33						621.32	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	028	0	1	02	01	H2663_028_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	028	0	1	02	01	H2663_028_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H2663_028_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	028	0	1	02	01	H2663_028_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H2663_028_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	028	0	1	02	01	H2663_028_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	028	0	1	02	01	H2663_028_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											898.15	33						362.68	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	029	0	1	02	01	H2663_029_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	029	0	1	02	01	H2663_029_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H2663_029_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	029	0	1	02	01	H2663_029_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H2663_029_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	029	0	1	02	01	H2663_029_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	029	0	1	02	01	H2663_029_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											923.02	33						432.91	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	032	0	1	01	01	H2663_032_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	032	0	1	01	01	H2663_032_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	032	0	1	01	01	H2663_032_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	032	0	1	01	01	H2663_032_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	032	0	1	01	01	H2663_032_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											988.58	33						367.12	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	034	0	1	01	01	H2663_034_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	034	0	1	01	01	H2663_034_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	034	0	1	01	01	H2663_034_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	034	0	1	01	01	H2663_034_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	034	0	1	01	01	H2663_034_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											836.31	29						433.58	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	038	0	1	01	01	H2663_038_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	038	0	1	01	01	H2663_038_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	038	0	1	01	01	H2663_038_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	038	0	1	01	01	H2663_038_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	038	0	1	01	01	H2663_038_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	038	0	1	01	01	H2663_038_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	038	0	1	01	01	H2663_038_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											930.76	33						460.83	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	039	0	1	01	01	H2663_039_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	039	0	1	01	01	H2663_039_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	039	0	1	01	01	H2663_039_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	039	0	1	01	01	H2663_039_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	039	0	1	01	01	H2663_039_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	039	0	1	01	01	H2663_039_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	039	0	1	01	01	H2663_039_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											949.58	33						402.04	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	040	0	1	01	01	H2663_040_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	040	0	1	01	01	H2663_040_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	040	0	1	01	01	H2663_040_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	040	0	1	01	01	H2663_040_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	040	0	1	01	01	H2663_040_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	040	0	1	01	01	H2663_040_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	040	0	1	01	01	H2663_040_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											972.50	33						405.95	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	041	0	1	01	01	H2663_041_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	041	0	1	01	01	H2663_041_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	041	0	1	01	01	H2663_041_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	041	0	1	01	01	H2663_041_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	041	0	1	01	01	H2663_041_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	041	0	1	01	01	H2663_041_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	041	0	1	01	01	H2663_041_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											982.41	33						359.90	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	042	0	1	01	01	H2663_042_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	042	0	1	01	01	H2663_042_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	042	0	1	01	01	H2663_042_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	042	0	1	01	01	H2663_042_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	042	0	1	01	01	H2663_042_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	042	0	1	01	01	H2663_042_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	042	0	1	01	01	H2663_042_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											955.15	33						392.75	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	043	0	1	01	01	H2663_043_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	043	0	1	01	01	H2663_043_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	043	0	1	01	01	H2663_043_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H2663	043	0	1	01	01	H2663_043_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	043	0	1	01	01	H2663_043_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	043	0	1	01	01	H2663_043_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	043	0	1	01	01	H2663_043_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											957.20	33						390.20	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2678	001	0	1	01	01	H2678_001_0	5	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	5	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	5	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	5	Non-Preferred Brand	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				96.74	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	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2678	001	0	1	01	01	H2678_001_0	5	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	4	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	4	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	4	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	4	Non-Preferred Brand	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				94.56	43		43																				43															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	002	0	1	01	01	H2678_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	003	0	1	01	01	H2678_003_0	4	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	7.00		21.00																					21.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	003	0	1	01	01	H2678_003_0	4	Generic	3	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	17.00		51.00																					51.00																17.00				17.00		0.57						0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	003	0	1	01	01	H2678_003_0	4	Preferred Brand	3	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 Brand, Specialty Tier												
H2678	003	0	1	01	01	H2678_003_0	4	Non-Preferred Brand	3	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				93.04	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	003	0	1	01	01	H2678_003_0	4	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	4	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	7.00		21.00																					21.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	004	0	1	01	01	H2678_004_0	4	Generic	3	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	17.00		51.00																					51.00																17.00				17.00		0.57						0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	004	0	1	01	01	H2678_004_0	4	Preferred Brand	3	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 Brand, Specialty Tier												
H2678	004	0	1	01	01	H2678_004_0	4	Non-Preferred Brand	3	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				99.08	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	004	0	1	01	01	H2678_004_0	4	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												
H2694	001	0	1	04	01	H2694_001_0	20	Preferred Generic	4	01	1	2	1	1	110		10	110		1	30		100				1	2	30		100					10	31	0.00		0.00																			0.00		0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2694	001	0	1	04	01	H2694_001_0	20	Generic	4	01	1	2	2	1	110		10	110		1	30		100				1	2	30		100					10	31	5.00		15.00																			5.00		5.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2694	001	0	1	04	01	H2694_001_0	20	Preferred Brand	4	10	1	2	3	1	110		10	110		1	30		100				1	2	30		100					10	31	47.00		141.00																			47.00		47.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2694	001	0	1	04	01	H2694_001_0	20	Non-Preferred Drug	4	10	1	2	4	1	110		10	110		1	30		100				1	2	30		100					10	31	100.00		300.00																			100.00		300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2694	001	0	1	04	01	H2694_001_0	20	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				100.00	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	001	0	1	01	01	H2697_001_0	8	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	8	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										2	2	
H2697	001	0	1	01	01	H2697_001_0	8	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	8	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										2	2	3
H2697	001	0	1	01	01	H2697_001_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				957.75	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	002	0	1	01	01	H2697_002_0	9	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	9	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										2	2	
H2697	002	0	1	01	01	H2697_002_0	9	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	9	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										2	2	3
H2697	002	0	1	01	01	H2697_002_0	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1043.83	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	003	0	1	01	01	H2697_003_0	9	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	9	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	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1086.26	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2722	002	0	1	02	01	H2722_002_0	12	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	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 Brand, Specialty Tier												
H2722	002	0	1	02	01	H2722_002_0	12	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	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 Brand, Specialty Tier										1		
H2722	002	0	1	02	01	H2722_002_0	12	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								16.00		48.00					16.00		48.00													48.00						48.00				16.00				16.00			0.52	0.52				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	002	0	1	02	01	H2722_002_0	12	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												
H2722	002	0	1	02	01	H2722_002_0	12	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												
H2722	002	0	1	02	01	H2722_002_0	12	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1708.73	25						781.37	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	003	0	1	02	01	H2722_003_0	14	Preferred Generic	2	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												
H2722	003	0	1	02	01	H2722_003_0	14	Generic	2	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								10.00		30.00					10.00		30.00													30.00						30.00				10.00				10.00			0.32	0.32				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	003	0	1	02	01	H2722_003_0	14	Preferred Brand	2	10	1	1	3	1		110	01		100	1				31		100	1	2						100	31		31											118.91	25		25				119.55	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	14	Non-Preferred Brand	2	10	1	1	4	1		110	01		100	1				31		100	1	2						100	31		31											116.74	25		25				111.83	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	14	Specialty Tier	2	10	1	1	5	1		010	01		010	1				31								31			31		31											1500.61	25						633.07	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	004	0	1	02	01	H2722_004_0	12	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												
H2722	004	0	1	02	01	H2722_004_0	12	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		
H2722	004	0	1	02	01	H2722_004_0	12	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												
H2722	004	0	1	02	01	H2722_004_0	12	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												
H2722	004	0	1	02	01	H2722_004_0	12	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												
H2722	004	0	1	02	01	H2722_004_0	12	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1637.09	25						787.90	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2737	001	0	1	04	01	H2737_001_0	7	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	001	0	1	04	01	H2737_001_0	7	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	001	0	1	04	01	H2737_001_0	7	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	001	0	1	04	01	H2737_001_0	7	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												
H2737	001	0	1	04	01	H2737_001_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1.00	26																																					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	002	0	1	04	01	H2737_002_0	7	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	002	0	1	04	01	H2737_002_0	7	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	002	0	1	04	01	H2737_002_0	7	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	002	0	1	04	01	H2737_002_0	7	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												
H2737	002	0	1	04	01	H2737_002_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1.00	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2752	001	0	1	01	01	H2752_001_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	14.00					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												
H2752	001	0	1	01	01	H2752_001_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		
H2752	001	0	1	01	01	H2752_001_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					4.00	8.00	8.00											15.00	30.00	30.00				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												
H2752	001	0	1	01	01	H2752_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2752	001	0	1	01	01	H2752_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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												
H2752	001	0	1	01	01	H2752_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											878.71	33						744.78	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2765	002	0	1	01	01	H2765_002_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	002	0	1	01	01	H2765_002_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	002	0	1	01	01	H2765_002_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	002	0	1	01	01	H2765_002_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	002	0	1	01	01	H2765_002_0	7	Preferred Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				230.00	23																				23																	23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	002	0	1	01	01	H2765_002_0	7	Specialty Tier	4	11	1	1	6	1	010		01	010		1	30								30						30		31				250.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	002	0	1	01	01	H2765_002_0	7	Vaccines	4	10	1	2	7	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	7	Preferred Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				230.00	24																				24																	24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	7	Specialty Tier	4	11	1	1	6	1	010		01	010		1	30								30						30		31				250.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	7	Vaccines	4	10	1	2	7	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	004	0	1	02	01	H2765_004_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	004	0	1	02	01	H2765_004_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	004	0	1	02	01	H2765_004_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	004	0	1	02	01	H2765_004_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	004	0	1	02	01	H2765_004_0	7	Preferred Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				230.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	004	0	1	02	01	H2765_004_0	7	Specialty Tier	4	11	1	1	6	1	010		01	010		1	30								30						30		31				250.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	004	0	1	02	01	H2765_004_0	7	Vaccines	4	10	1	2	7	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2775	105	0	1	04	01	H2775_105_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	105	0	1	04	01	H2775_105_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H2775	105	0	1	04	01	H2775_105_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H2775	105	0	1	04	01	H2775_105_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.69	45	45	45				94.30	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	105	0	1	04	01	H2775_105_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	105	0	1	04	01	H2775_105_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	106	0	1	04	01	H2775_106_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	106	0	1	04	01	H2775_106_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H2775	106	0	1	04	01	H2775_106_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H2775	106	0	1	04	01	H2775_106_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.11	44	44	44				94.60	42	42	42										44	44	44				42	42	42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	106	0	1	04	01	H2775_106_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	106	0	1	04	01	H2775_106_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	106	0	1	04	01	H2775_106_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2775	109	0	1	04	01	H2775_109_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	109	0	1	04	01	H2775_109_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	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, Select Care Drugs												
H2775	109	0	1	04	01	H2775_109_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H2775	109	0	1	04	01	H2775_109_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.28	47	47	47				95.05	45	45	45										47	47	47				45	45	45			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	109	0	1	04	01	H2775_109_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	109	0	1	04	01	H2775_109_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	111	0	1	04	01	H2775_111_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	111	0	1	04	01	H2775_111_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H2775	111	0	1	04	01	H2775_111_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H2775	111	0	1	04	01	H2775_111_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											91.82	50	50	50				88.15	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	111	0	1	04	01	H2775_111_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	111	0	1	04	01	H2775_111_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	111	0	1	04	01	H2775_111_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2775	112	0	1	04	01	H2775_112_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	112	0	1	04	01	H2775_112_0	5	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	15.00				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												
H2775	112	0	1	04	01	H2775_112_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	112	0	1	04	01	H2775_112_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.31	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	112	0	1	04	01	H2775_112_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	112	0	1	04	01	H2775_112_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	113	0	1	04	01	H2775_113_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	113	0	1	04	01	H2775_113_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	113	0	1	04	01	H2775_113_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	113	0	1	04	01	H2775_113_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.02	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	113	0	1	04	01	H2775_113_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	113	0	1	04	01	H2775_113_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	114	0	1	04	01	H2775_114_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	114	0	1	04	01	H2775_114_0	6	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	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	114	0	1	04	01	H2775_114_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	114	0	1	04	01	H2775_114_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.02	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	114	0	1	04	01	H2775_114_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	114	0	1	04	01	H2775_114_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	115	0	1	04	01	H2775_115_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	115	0	1	04	01	H2775_115_0	6	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	5.00	10.00	15.00																									5.00	10.00	15.00				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												
H2775	115	0	1	04	01	H2775_115_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	115	0	1	04	01	H2775_115_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.31	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	115	0	1	04	01	H2775_115_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	115	0	1	04	01	H2775_115_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2782	002	0	1	01	01	H2782_002_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2782	002	0	1	01	01	H2782_002_0	5	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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, Vaccines										1		
H2782	002	0	1	01	01	H2782_002_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					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, Vaccines												
H2782	002	0	1	01	01	H2782_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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, Vaccines												
H2782	002	0	1	01	01	H2782_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2782	002	0	1	01	01	H2782_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2782	002	0	1	01	01	H2782_002_0	5	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2782	002	0	1	01	01	H2782_002_0	5	Vaccines	4	10	1	2	6	3		010	01	010		1				30					30						30		31								0.00							0.00							0.00																		0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H2782	003	0	1	01	01	H2782_003_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2782	003	0	1	01	01	H2782_003_0	5	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H2782	003	0	1	01	01	H2782_003_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					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, Vaccines												
H2782	003	0	1	01	01	H2782_003_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					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, Vaccines												
H2782	003	0	1	01	01	H2782_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					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, Vaccines												
H2782	003	0	1	01	01	H2782_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2782	003	0	1	01	01	H2782_003_0	5	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2782	003	0	1	01	01	H2782_003_0	5	Vaccines	4	10	1	2	6	3		010	01	010		1				30					30						30		31								0.00							0.00							0.00																		0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H2793	003	0	1	01	01	H2793_003_0	8	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				925.83	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	004	0	1	01	01	H2793_004_0	9	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	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	Generic	4	11	3	1	2	1	110		01	100		1	30		90				1	2			90				30		31				14.57	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	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	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				121.74	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	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				50.81	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	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				619.70	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	005	0	1	01	01	H2793_005_0	9	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2793	005	0	1	01	01	H2793_005_0	9	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	9	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	9	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	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				947.26	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	9	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	3.00		6.00																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2802	001	0	1	02	01	H2802_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	02	01	H2802_001_0	3	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		
H2802	001	0	1	02	01	H2802_001_0	3	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												
H2802	001	0	1	02	01	H2802_001_0	3	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
H2802	001	0	1	02	01	H2802_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	02	01	H2802_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	02	01	H2802_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				257.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	02	01	H2802_007_0	5	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												
H2802	007	0	1	02	01	H2802_007_0	5	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		
H2802	007	0	1	02	01	H2802_007_0	5	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												
H2802	007	0	1	02	01	H2802_007_0	5	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
H2802	007	0	1	02	01	H2802_007_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												
H2802	007	0	1	02	01	H2802_007_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												
H2802	007	0	1	02	01	H2802_007_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				442.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	02	01	H2802_008_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	02	01	H2802_008_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	008	0	1	02	01	H2802_008_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	02	01	H2802_008_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	008	0	1	02	01	H2802_008_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	02	01	H2802_008_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	02	01	H2802_008_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				271.00	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	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												
H2802	010	0	1	02	01	H2802_010_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	010	0	1	02	01	H2802_010_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	02	01	H2802_010_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	010	0	1	02	01	H2802_010_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	02	01	H2802_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	02	01	H2802_010_0	3	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												
H2802	012	0	1	02	01	H2802_012_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	02	01	H2802_012_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	012	0	1	02	01	H2802_012_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	02	01	H2802_012_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	012	0	1	02	01	H2802_012_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	02	01	H2802_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	02	01	H2802_012_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				354.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	02	01	H2802_016_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	02	01	H2802_016_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	016	0	1	02	01	H2802_016_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	02	01	H2802_016_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	016	0	1	02	01	H2802_016_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	02	01	H2802_016_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	02	01	H2802_016_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				275.00	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	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												
H2802	018	0	1	02	01	H2802_018_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	018	0	1	02	01	H2802_018_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	02	01	H2802_018_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	018	0	1	02	01	H2802_018_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	02	01	H2802_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	02	01	H2802_018_0	3	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												
H2802	020	0	1	02	01	H2802_020_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	02	01	H2802_020_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	020	0	1	02	01	H2802_020_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	02	01	H2802_020_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	020	0	1	02	01	H2802_020_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	02	01	H2802_020_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	02	01	H2802_020_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				262.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	3	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		
H2802	024	0	1	01	01	H2802_024_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	024	0	1	01	01	H2802_024_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				406.00	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	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												
H2802	025	0	1	01	01	H2802_025_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	025	0	1	01	01	H2802_025_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	01	01	H2802_025_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	025	0	1	01	01	H2802_025_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				226.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	02	01	H2802_028_0	3	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												
H2802	028	0	1	02	01	H2802_028_0	3	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		
H2802	028	0	1	02	01	H2802_028_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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												
H2802	028	0	1	02	01	H2802_028_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	02	01	H2802_028_0	3	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												
H2802	029	0	1	02	01	H2802_029_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	02	01	H2802_029_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H2802	029	0	1	02	01	H2802_029_0	3	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												
H2802	029	0	1	02	01	H2802_029_0	3	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
H2802	029	0	1	02	01	H2802_029_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	02	01	H2802_029_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	02	01	H2802_029_0	3	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												
H2802	030	0	1	02	01	H2802_030_0	3	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												
H2802	030	0	1	02	01	H2802_030_0	3	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		
H2802	030	0	1	02	01	H2802_030_0	3	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												
H2802	030	0	1	02	01	H2802_030_0	3	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
H2802	030	0	1	02	01	H2802_030_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	02	01	H2802_030_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	02	01	H2802_030_0	3	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												
H2802	031	0	1	02	01	H2802_031_0	3	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												
H2802	031	0	1	02	01	H2802_031_0	3	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		
H2802	031	0	1	02	01	H2802_031_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	02	01	H2802_031_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H2802	031	0	1	02	01	H2802_031_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	02	01	H2802_031_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	02	01	H2802_031_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				510.00	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	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												
H2802	032	0	1	02	01	H2802_032_0	3	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		
H2802	032	0	1	02	01	H2802_032_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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												
H2802	032	0	1	02	01	H2802_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	02	01	H2802_032_0	3	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												
H2802	033	0	1	02	01	H2802_033_0	3	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												
H2802	033	0	1	02	01	H2802_033_0	3	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		
H2802	033	0	1	02	01	H2802_033_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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												
H2802	033	0	1	02	01	H2802_033_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	02	01	H2802_033_0	3	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												
H2802	034	0	1	02	01	H2802_034_0	3	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												
H2802	034	0	1	02	01	H2802_034_0	3	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		
H2802	034	0	1	02	01	H2802_034_0	3	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												
H2802	034	0	1	02	01	H2802_034_0	3	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
H2802	034	0	1	02	01	H2802_034_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	02	01	H2802_034_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	02	01	H2802_034_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				491.00	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	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												
H2802	035	0	1	02	01	H2802_035_0	3	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		
H2802	035	0	1	02	01	H2802_035_0	3	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												
H2802	035	0	1	02	01	H2802_035_0	3	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
H2802	035	0	1	02	01	H2802_035_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	02	01	H2802_035_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	02	01	H2802_035_0	3	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												
H2802	041	0	1	01	01	H2802_041_0	5	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												
H2802	041	0	1	01	01	H2802_041_0	5	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		
H2802	041	0	1	01	01	H2802_041_0	5	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												
H2802	041	0	1	01	01	H2802_041_0	5	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
H2802	041	0	1	01	01	H2802_041_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												
H2802	041	0	1	01	01	H2802_041_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												
H2802	041	0	1	01	01	H2802_041_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				418.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	01	01	H2802_048_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	01	01	H2802_048_0	3	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		
H2802	048	0	1	01	01	H2802_048_0	3	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												
H2802	048	0	1	01	01	H2802_048_0	3	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
H2802	048	0	1	01	01	H2802_048_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	01	01	H2802_048_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	01	01	H2802_048_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				545.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	049	0	1	02	01	H2802_049_0	3	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												
H2802	049	0	1	02	01	H2802_049_0	3	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		
H2802	049	0	1	02	01	H2802_049_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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												
H2802	049	0	1	02	01	H2802_049_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	049	0	1	02	01	H2802_049_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				473.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	052	0	1	02	01	H2802_052_0	3	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												
H2802	052	0	1	02	01	H2802_052_0	3	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		
H2802	052	0	1	02	01	H2802_052_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	052	0	1	02	01	H2802_052_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H2802	052	0	1	02	01	H2802_052_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	052	0	1	02	01	H2802_052_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	052	0	1	02	01	H2802_052_0	3	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												
H2816	013	0	1	09	04	H2816_013_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2816	013	0	1	09	04	H2816_013_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H2816	013	0	1	09	04	H2816_013_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H2816	013	0	1	09	04	H2816_013_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.55	44	44	44				95.02	42	42	42										44	44	44				42	42	42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2816	013	0	1	09	04	H2816_013_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2816	013	0	1	09	04	H2816_013_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2816	019	0	1	09	04	H2816_019_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2816	019	0	1	09	04	H2816_019_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H2816	019	0	1	09	04	H2816_019_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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												
H2816	019	0	1	09	04	H2816_019_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.25	50	50	50				95.28	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2816	019	0	1	09	04	H2816_019_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2816	019	0	1	09	04	H2816_019_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2825	001	0	1	01	01	H2825_001_0	8	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					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	8	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	8	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	97.50																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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					90.00	180.00	225.00																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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											662.72	33						662.72	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	002	0	1	01	01	H2825_002_0	7	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					2.00	4.00	6.00					2.00	4.00	5.00																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	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	17.50																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	Preferred Brand	4	11	1	2	3	1		111	01	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												
H2825	002	0	1	01	01	H2825_002_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					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												
H2825	002	0	1	01	01	H2825_002_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											708.19	33						708.19	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	003	0	1	01	01	H2825_003_0	9	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	003	0	1	01	01	H2825_003_0	9	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	003	0	1	01	01	H2825_003_0	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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												
H2825	003	0	1	01	01	H2825_003_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	237.50																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	003	0	1	01	01	H2825_003_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											714.87	33						714.87	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2836	005	0	1	04	01	H2836_005_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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												
H2836	005	0	1	04	01	H2836_005_0	6	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					0.00	0.00	0.00																18.00				18.00			0.60	0.43	0.00			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	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	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	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	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	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		
H2836	006	0	1	04	01	H2836_006_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H2836	006	0	1	04	01	H2836_006_0	7	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												
H2836	006	0	1	04	01	H2836_006_0	7	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												
H2836	006	0	1	04	01	H2836_006_0	7	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												
H2836	006	0	1	04	01	H2836_006_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2836	006	0	1	04	01	H2836_006_0	7	Select Care Drugs	4	01	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	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												
H2853	001	0	1	01	01	H2853_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	001	0	1	01	01	H2853_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	0.00				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	001	0	1	01	01	H2853_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H2853	001	0	1	01	01	H2853_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H2853	001	0	1	01	01	H2853_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	001	0	1	01	01	H2853_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	002	0	1	01	01	H2853_002_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2853	002	0	1	01	01	H2853_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	002	0	1	01	01	H2853_002_0	4	Generic	4	11	1	2	2	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											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2853	002	0	1	01	01	H2853_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H2853	002	0	1	01	01	H2853_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H2853	002	0	1	01	01	H2853_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	002	0	1	01	01	H2853_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2879	001	0	1	01	01	H2879_001_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.11	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				708.71	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	002	0	1	01	01	H2879_002_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2879	002	0	1	01	01	H2879_002_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2879	002	0	1	01	01	H2879_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2879	002	0	1	01	01	H2879_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2879	002	0	1	01	01	H2879_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				973.87	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2879	002	0	1	01	01	H2879_002_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2879	003	0	1	01	01	H2879_003_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2879	003	0	1	01	01	H2879_003_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2879	003	0	1	01	01	H2879_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2879	003	0	1	01	01	H2879_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2879	003	0	1	01	01	H2879_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				973.87	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2879	003	0	1	01	01	H2879_003_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	002	0	1	01	01	H2915_002_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	002	0	1	01	01	H2915_002_0	4	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	15.00				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												
H2915	002	0	1	01	01	H2915_002_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	37.00	74.00	111.00																									37.00	74.00	111.00				37.00	74.00	74.00				37.00				37.00		1.23				1.23	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	002	0	1	01	01	H2915_002_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				90.51	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	002	0	1	01	01	H2915_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	002	0	1	01	01	H2915_002_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	003	0	1	01	01	H2915_003_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	003	0	1	01	01	H2915_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H2915	003	0	1	01	01	H2915_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H2915	003	0	1	01	01	H2915_003_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.89	47	47	47				94.68	45	45	45										47	47	47				45	45	45			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	003	0	1	01	01	H2915_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	003	0	1	01	01	H2915_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	007	0	1	01	01	H2915_007_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	7.00	14.00	21.00																									7.00	14.00	21.00				7.00	14.00	0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	007	0	1	01	01	H2915_007_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	007	0	1	01	01	H2915_007_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				96.64	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	007	0	1	01	01	H2915_007_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	007	0	1	01	01	H2915_007_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	011	0	1	01	01	H2915_011_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	011	0	1	01	01	H2915_011_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	011	0	1	01	01	H2915_011_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H2915	011	0	1	01	01	H2915_011_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.46	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	011	0	1	01	01	H2915_011_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	011	0	1	01	01	H2915_011_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	012	0	1	01	01	H2915_012_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	012	0	1	01	01	H2915_012_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H2915	012	0	1	01	01	H2915_012_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H2915	012	0	1	01	01	H2915_012_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.10	50	50	50				90.33	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	012	0	1	01	01	H2915_012_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	012	0	1	01	01	H2915_012_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	016	0	1	01	01	H2915_016_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	016	0	1	01	01	H2915_016_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H2915	016	0	1	01	01	H2915_016_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H2915	016	0	1	01	01	H2915_016_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.44	48	48	48				95.30	46	46	46										48	48	48				46	46	46			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	016	0	1	01	01	H2915_016_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	016	0	1	01	01	H2915_016_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred 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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2960	012	0	1	01	01	H2960_012_0	8	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								11.00	22.00	27.50					5.00	10.00	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	8	Generic	4	01	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								20.00	40.00	50.00					12.00	24.00	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	8	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	117.50					41.00	82.00	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	8	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	250.00					94.00	188.00	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	100		1				30	60	100	1	2			100				30		31								8.50	17.00	21.25					2.50	5.00	6.25							0.00																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	8	Select Care Drugs	4	01	1	2	6	3		111	01	100		1				30	60	100	1	2			100				30		31								8.50	17.00	21.25					2.50	5.00	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		
H2960	018	0	1	01	01	H2960_018_0	7	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								6.00	12.00	15.00					0.00	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	7	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	1	2			100				30		31								6.00	12.00	15.00					0.00	0.00	0.00							0.00																6.00				6.00			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	7	Generic	4	01	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								8.00	16.00	20.00					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 Brand, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	7	Generic	4	01	1	2	2	3		111	01	100		1				30	60	100	1	2			100				30		31								8.00	16.00	20.00					0.00	0.00	0.00							0.00																8.00				8.00			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	7	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	117.50					41.00	82.00	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	7	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	250.00					94.00	188.00	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	100		1				30	60	100	1	2			100				30		31								6.00	12.00	15.00					0.00	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	7	Select Care Drugs	4	01	1	2	6	3		111	01	100		1				30	60	100	1	2			100				30		31								6.00	12.00	15.00					0.00	0.00	0.00							0.00																6.00				6.00			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	5	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								8.00	16.00	20.00					2.00	4.00	5.00							4.00																8.00				8.00			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	5	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	1	2			100				30		31								8.00	16.00	20.00					2.00	4.00	5.00							4.00																8.00				8.00			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	5	Generic	4	01	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								16.00	32.00	40.00					8.00	16.00	20.00							16.00																16.00				16.00			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	5	Generic	4	01	1	2	2	3		111	01	100		1				30	60	100	1	2			100				30		31								16.00	32.00	40.00					8.00	16.00	20.00							16.00																16.00				16.00			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	5	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	117.50					41.00	82.00	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	019	0	1	01	01	H2960_019_0	5	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	250.00					94.00	188.00	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	019	0	1	01	01	H2960_019_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												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	5	Select Care Drugs	4	01	1	2	6	1		111	01	100		1				30	60	100	1	2			100				30		31								6.00	12.00	15.00					0.00	0.00	0.00							0.00																6.00				6.00			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	5	Select Care Drugs	4	01	1	2	6	3		111	01	100		1				30	60	100	1	2			100				30		31								6.00	12.00	15.00					0.00	0.00	0.00							0.00																6.00				6.00			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	5	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								8.00	16.00	20.00					2.00	4.00	5.00							4.00																8.00				8.00			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	5	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	1	2			100				30		31								8.00	16.00	20.00					2.00	4.00	5.00							4.00																8.00				8.00			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	5	Generic	4	01	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								16.00	32.00	40.00					8.00	16.00	20.00							16.00																16.00				16.00			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	5	Generic	4	01	1	2	2	3		111	01	100		1				30	60	100	1	2			100				30		31								16.00	32.00	40.00					8.00	16.00	20.00							16.00																16.00				16.00			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	5	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	117.50					41.00	82.00	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	021	0	1	01	01	H2960_021_0	5	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	250.00					94.00	188.00	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	021	0	1	01	01	H2960_021_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	021	0	1	01	01	H2960_021_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	100		1				30	60	100	1	2			100				30		31								6.00	12.00	15.00					0.00	0.00	0.00							0.00																6.00				6.00			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	5	Select Care Drugs	4	01	1	2	6	3		111	01	100		1				30	60	100	1	2			100				30		31								6.00	12.00	15.00					0.00	0.00	0.00							0.00																6.00				6.00			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	5	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								8.00	16.00	20.00					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 Brand, Specialty Tier, Select Care Drugs												
H2960	022	0	1	01	01	H2960_022_0	5	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	1	2			100				30		31								8.00	16.00	20.00					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 Brand, Specialty Tier, Select Care Drugs										1		
H2960	022	0	1	01	01	H2960_022_0	5	Generic	4	01	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	37.50					5.00	10.00	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	5	Generic	4	01	1	2	2	3		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	37.50					5.00	10.00	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	5	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	117.50					37.00	74.00	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	5	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								95.00	190.00	237.50					85.00	170.00	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	022	0	1	01	01	H2960_022_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	100		1				30	60	100	1	2			100				30		31								8.00	16.00	20.00					0.00	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	5	Select Care Drugs	4	01	1	2	6	3		111	01	100		1				30	60	100	1	2			100				30		31								8.00	16.00	20.00					0.00	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	6	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								11.00	22.00	27.50					5.00	10.00	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	6	Generic	4	01	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								20.00	40.00	50.00					12.00	24.00	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	6	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	117.50					41.00	82.00	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	6	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	250.00					94.00	188.00	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	023	0	1	01	01	H2960_023_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	100		1				30	60	100	1	2			100				30		31								8.50	17.00	21.25					2.50	5.00	6.25							0.00																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	6	Select Care Drugs	4	01	1	2	6	3		111	01	100		1				30	60	100	1	2			100				30		31								8.50	17.00	21.25					2.50	5.00	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	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2962	001	0	1	01	01	H2962_001_0	7	Preferred Brand	4	11	1	2	2	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				883.43	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	3	1	01	01	H2962_013_3	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	3	1	01	01	H2962_013_3	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2962	013	3	1	01	01	H2962_013_3	7	Preferred Brand	4	11	1	2	2	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	3	1	01	01	H2962_013_3	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				922.47	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	4	1	01	01	H2962_013_4	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	4	1	01	01	H2962_013_4	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2962	013	4	1	01	01	H2962_013_4	7	Preferred Brand	4	11	1	2	2	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	4	1	01	01	H2962_013_4	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				922.47	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	1	1	01	01	H2962_014_1	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	1	1	01	01	H2962_014_1	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2962	014	1	1	01	01	H2962_014_1	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	25.00		75.00																					50.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	1	1	01	01	H2962_014_1	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	50.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				811.84	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	2	1	01	01	H2962_014_2	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	2	1	01	01	H2962_014_2	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2962	014	2	1	01	01	H2962_014_2	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	25.00		75.00																					50.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	2	1	01	01	H2962_014_2	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	50.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				811.84	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	016	0	1	01	01	H2962_016_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	016	0	1	01	01	H2962_016_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2962	016	0	1	01	01	H2962_016_0	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	30.00		90.00																					60.00																30.00				30.00		1.00						0.97	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	016	0	1	01	01	H2962_016_0	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	70.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				857.01	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	019	1	1	01	01	H2962_019_1	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	1	1	01	01	H2962_019_1	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2962	019	1	1	01	01	H2962_019_1	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		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	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				837.86	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	1	1	01	01	H2962_019_1	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	1	1	01	01	H2962_019_1	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	019	2	1	01	01	H2962_019_2	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	2	1	01	01	H2962_019_2	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2962	019	2	1	01	01	H2962_019_2	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		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	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				837.86	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	2	1	01	01	H2962_019_2	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	2	1	01	01	H2962_019_2	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	021	0	1	01	01	H2962_021_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	021	0	1	01	01	H2962_021_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2962	021	0	1	01	01	H2962_021_0	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	25.00		75.00																					50.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	021	0	1	01	01	H2962_021_0	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				930.89	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	021	0	1	01	01	H2962_021_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	021	0	1	01	01	H2962_021_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	022	0	1	01	01	H2962_022_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	022	0	1	01	01	H2962_022_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2962	022	0	1	01	01	H2962_022_0	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	25.00		75.00																					50.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	022	0	1	01	01	H2962_022_0	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				873.68	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	022	0	1	01	01	H2962_022_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	022	0	1	01	01	H2962_022_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	023	0	1	01	01	H2962_023_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	023	0	1	01	01	H2962_023_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2962	023	0	1	01	01	H2962_023_0	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	25.00		75.00																					50.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	023	0	1	01	01	H2962_023_0	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				919.58	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	023	0	1	01	01	H2962_023_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	023	0	1	01	01	H2962_023_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	024	0	1	01	01	H2962_024_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	024	0	1	01	01	H2962_024_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2962	024	0	1	01	01	H2962_024_0	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		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	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				872.15	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	024	0	1	01	01	H2962_024_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	024	0	1	01	01	H2962_024_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	025	0	1	01	01	H2962_025_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	025	0	1	01	01	H2962_025_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2962	025	0	1	01	01	H2962_025_0	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		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	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				918.80	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	025	0	1	01	01	H2962_025_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	025	0	1	01	01	H2962_025_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	026	0	1	01	01	H2962_026_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	026	0	1	01	01	H2962_026_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2962	026	0	1	01	01	H2962_026_0	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		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	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				870.46	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	026	0	1	01	01	H2962_026_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	026	0	1	01	01	H2962_026_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	027	0	1	01	01	H2962_027_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	027	0	1	01	01	H2962_027_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2962	027	0	1	01	01	H2962_027_0	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		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	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				918.00	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	027	0	1	01	01	H2962_027_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	027	0	1	01	01	H2962_027_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	028	0	1	01	01	H2962_028_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	028	0	1	01	01	H2962_028_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2962	028	0	1	01	01	H2962_028_0	7	Preferred Brand	4	11	1	2	2	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	028	0	1	01	01	H2962_028_0	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				884.43	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	029	0	1	01	01	H2962_029_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	029	0	1	01	01	H2962_029_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2962	029	0	1	01	01	H2962_029_0	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		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	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				874.66	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	029	0	1	01	01	H2962_029_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	029	0	1	01	01	H2962_029_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	030	0	1	01	01	H2962_030_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	030	0	1	01	01	H2962_030_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2962	030	0	1	01	01	H2962_030_0	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		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	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		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	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				920.62	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	030	0	1	01	01	H2962_030_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	030	0	1	01	01	H2962_030_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	031	0	1	01	01	H2962_031_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	031	0	1	01	01	H2962_031_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2962	031	0	1	01	01	H2962_031_0	7	Preferred Brand	4	11	1	2	2	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	031	0	1	01	01	H2962_031_0	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	70.00		210.00																					140.00																70.00				70.00		2.33						2.26	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	031	0	1	01	01	H2962_031_0	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				878.61	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	032	0	1	01	01	H2962_032_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	032	0	1	01	01	H2962_032_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2962	032	0	1	01	01	H2962_032_0	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	25.00		75.00																					50.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	032	0	1	01	01	H2962_032_0	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	032	0	1	01	01	H2962_032_0	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				852.25	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	033	0	1	01	01	H2962_033_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	033	0	1	01	01	H2962_033_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2962	033	0	1	01	01	H2962_033_0	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		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	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	70.00		210.00																					140.00																70.00				70.00		2.33						2.26	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	033	0	1	01	01	H2962_033_0	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				869.41	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	033	0	1	01	01	H2962_033_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	033	0	1	01	01	H2962_033_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	034	0	1	01	01	H2962_034_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	034	0	1	01	01	H2962_034_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2962	034	0	1	01	01	H2962_034_0	7	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		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	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	70.00		210.00																					140.00																70.00				70.00		2.33						2.26	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	034	0	1	01	01	H2962_034_0	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				915.48	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	034	0	1	01	01	H2962_034_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	034	0	1	01	01	H2962_034_0	7	Select Care Drugs	4	11	1	2	5	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	045	0	1	01	01	H2962_045_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	045	0	1	01	01	H2962_045_0	7	Generic	4	01	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2962	045	0	1	01	01	H2962_045_0	7	Preferred Brand	4	11	1	2	2	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	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	045	0	1	01	01	H2962_045_0	7	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	60.00		180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	045	0	1	01	01	H2962_045_0	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				879.26	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2986	001	0	1	01	01	H2986_001_0	13	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	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	13	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	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	13	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	001	0	1	01	01	H2986_001_0	13	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	001	0	1	01	01	H2986_001_0	13	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																					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	13	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				537.94	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	13	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H2986	001	0	1	01	01	H2986_001_0	13	Select Care Drugs	4	01	1	2	6	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 Brand, Specialty Tier, Select Care Drugs										1		
H2986	002	0	1	01	01	H2986_002_0	12	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	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	12	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	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	12	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	002	0	1	01	01	H2986_002_0	12	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	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	12	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																					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	12	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				707.27	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	002	0	1	01	01	H2986_002_0	12	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H2986	002	0	1	01	01	H2986_002_0	12	Select Care Drugs	4	01	1	2	6	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 Brand, Specialty Tier, Select Care Drugs										1		
H2986	004	0	1	01	01	H2986_004_0	12	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	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	12	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	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	12	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	004	0	1	01	01	H2986_004_0	12	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	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	12	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																					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	12	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				793.74	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	12	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H2986	004	0	1	01	01	H2986_004_0	12	Select Care Drugs	4	01	1	2	6	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 Brand, Specialty Tier, Select Care Drugs										1		
H2986	007	0	1	01	01	H2986_007_0	13	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	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	13	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	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	13	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	007	0	1	01	01	H2986_007_0	13	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	007	0	1	01	01	H2986_007_0	13	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																					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	13	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				780.20	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	007	0	1	01	01	H2986_007_0	13	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H2986	007	0	1	01	01	H2986_007_0	13	Select Care Drugs	4	01	1	2	6	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 Brand, Specialty Tier, Select Care Drugs										1		
H3047	001	0	1	04	01	H3047_001_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3047	001	0	1	04	01	H3047_001_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3047	001	0	1	04	01	H3047_001_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H3047	001	0	1	04	01	H3047_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3047	001	0	1	04	01	H3047_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3047	001	0	1	04	01	H3047_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3047	001	0	1	04	01	H3047_001_0	4	Select Care Drugs	4	11	1	2	6	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H3047	002	0	1	04	01	H3047_002_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3047	002	0	1	04	01	H3047_002_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3047	002	0	1	04	01	H3047_002_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H3047	002	0	1	04	01	H3047_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	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, Select Care Drugs												
H3047	002	0	1	04	01	H3047_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3047	002	0	1	04	01	H3047_002_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3047	002	0	1	04	01	H3047_002_0	4	Select Care Drugs	4	11	1	2	6	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H3047	004	0	1	04	01	H3047_004_0	4	Preferred Generic	4	11	3	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, Select Care Drugs												
H3047	004	0	1	04	01	H3047_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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												
H3047	004	0	1	04	01	H3047_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H3047	004	0	1	04	01	H3047_004_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											96.77	45	45	45				92.47	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3047	004	0	1	04	01	H3047_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3047	004	0	1	04	01	H3047_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3071	002	0	1	01	01	H3071_002_0	6	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	5.00					0.00	0.00	0.00											5.00	10.00	5.00				0.00	0.00	0.00				0.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	10.00					12.00	24.00	5.00											17.00	34.00	10.00				12.00	24.00	5.00				12.00				12.00			0.57	0.40		0.57	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	250.00					95.00	190.00	237.50											100.00	200.00	250.00				95.00	190.00	237.50				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	6	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											766.82	33	33	33				766.82	33	33	33										33	33	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	6	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	5.00					0.00	0.00	0.00											5.00	10.00	5.00				0.00	0.00	0.00				0.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	003	0	1	02	01	H3071_003_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	10.00					12.00	24.00	5.00											17.00	34.00	10.00				12.00	24.00	5.00				12.00				12.00			0.57	0.40		0.57	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	003	0	1	02	01	H3071_003_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	003	0	1	02	01	H3071_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	250.00					95.00	190.00	237.50											100.00	200.00	250.00				95.00	190.00	237.50				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	003	0	1	02	01	H3071_003_0	6	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											775.05	33	33	33				775.05	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	4	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												
H3113	008	0	1	02	01	H3113_008_0	4	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
H3113	008	0	1	02	01	H3113_008_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				350.00	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	Generic	4	01	1	1	1	1	110		01			1	30		100				1	2							30		34				4.74	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	Preferred Brand	4	11	1	1	2	1	110		01			1	30		100				1	2							30		34				80.94	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	Non-Preferred Brand	4	10	1	1	3	1	110		01			1	30		100				1	1							30		34				259.19	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	Specialty Tier	4	10	1	1	4	1	110		01			1	30		100				1	1							30		34				783.80	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	Select Care Drugs	4	01	1	1	5	1	110		01			1	30		100				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	Select Care Drugs	4	01	1	1	5	3	110		01			1	30		100				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	02	01	H3146_001_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3146	001	0	1	02	01	H3146_001_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3146_001_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3146	001	0	1	02	01	H3146_001_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3146_001_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	001	0	1	02	01	H3146_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	001	0	1	02	01	H3146_001_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1044.55	33						680.66	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	002	0	1	01	01	H3146_002_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3146	002	0	1	01	01	H3146_002_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3146	002	0	1	01	01	H3146_002_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	002	0	1	01	01	H3146_002_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											44.58	25	25	25				42.26	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	002	0	1	01	01	H3146_002_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											638.19	25						427.64	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	003	0	1	01	01	H3146_003_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3146	003	0	1	01	01	H3146_003_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3146	003	0	1	01	01	H3146_003_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	003	0	1	01	01	H3146_003_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											43.95	25	25	25				41.72	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	003	0	1	01	01	H3146_003_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											626.18	25						415.04	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	004	0	1	02	01	H3146_004_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3146	004	0	1	02	01	H3146_004_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3146_004_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3146	004	0	1	02	01	H3146_004_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3146_004_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	004	0	1	02	01	H3146_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	004	0	1	02	01	H3146_004_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											998.69	33						448.29	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	005	0	1	01	01	H3146_005_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	005	0	1	01	01	H3146_005_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H3146	005	0	1	01	01	H3146_005_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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		
H3146	005	0	1	01	01	H3146_005_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	005	0	1	01	01	H3146_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	005	0	1	01	01	H3146_005_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											965.23	31						407.89	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	006	0	1	01	01	H3146_006_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	006	0	1	01	01	H3146_006_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H3146	006	0	1	01	01	H3146_006_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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		
H3146	006	0	1	01	01	H3146_006_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	006	0	1	01	01	H3146_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	006	0	1	01	01	H3146_006_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											967.79	31						404.27	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	007	0	1	02	01	H3146_007_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	007	0	1	02	01	H3146_007_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3146_007_0	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	007	0	1	02	01	H3146_007_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3146_007_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	007	0	1	02	01	H3146_007_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	007	0	1	02	01	H3146_007_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1015.04	33						422.50	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	008	0	1	01	01	H3146_008_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								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												
H3146	008	0	1	01	01	H3146_008_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3146	008	0	1	01	01	H3146_008_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	008	0	1	01	01	H3146_008_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											44.70	25	25	25				42.61	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	008	0	1	01	01	H3146_008_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											635.28	25						419.64	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	009	0	1	01	01	H3146_009_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3146	009	0	1	01	01	H3146_009_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3146	009	0	1	01	01	H3146_009_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	009	0	1	01	01	H3146_009_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											44.72	25	25	25				42.63	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	009	0	1	01	01	H3146_009_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											635.37	25						419.75	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	010	0	1	01	01	H3146_010_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	010	0	1	01	01	H3146_010_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H3146	010	0	1	01	01	H3146_010_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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		
H3146	010	0	1	01	01	H3146_010_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	010	0	1	01	01	H3146_010_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	010	0	1	01	01	H3146_010_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											966.81	31						405.65	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	011	0	1	01	01	H3146_011_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	011	0	1	01	01	H3146_011_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H3146	011	0	1	01	01	H3146_011_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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		
H3146	011	0	1	01	01	H3146_011_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	011	0	1	01	01	H3146_011_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	011	0	1	01	01	H3146_011_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											938.19	31						418.07	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	012	0	1	01	01	H3146_012_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	012	0	1	01	01	H3146_012_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H3146	012	0	1	01	01	H3146_012_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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		
H3146	012	0	1	01	01	H3146_012_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	012	0	1	01	01	H3146_012_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	012	0	1	01	01	H3146_012_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											895.98	31						401.75	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	013	0	1	01	01	H3146_013_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	013	0	1	01	01	H3146_013_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H3146	013	0	1	01	01	H3146_013_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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		
H3146	013	0	1	01	01	H3146_013_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	013	0	1	01	01	H3146_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	013	0	1	01	01	H3146_013_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											882.59	31						418.93	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	014	0	1	02	01	H3146_014_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	014	0	1	02	01	H3146_014_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	014	0	1	02	01	H3146_014_0	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	014	0	1	02	01	H3146_014_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	014	0	1	02	01	H3146_014_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	014	0	1	02	01	H3146_014_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	014	0	1	02	01	H3146_014_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1000.18	33						420.78	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	022	0	1	02	01	H3152_022_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	022	0	1	02	01	H3152_022_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3152_022_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	022	0	1	02	01	H3152_022_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	022	0	1	02	01	H3152_022_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	022	0	1	02	01	H3152_022_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	022	0	1	02	01	H3152_022_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											746.31	28						239.26	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	02	01	H3152_048_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	02	01	H3152_048_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3152_048_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	02	01	H3152_048_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	048	0	1	02	01	H3152_048_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	02	01	H3152_048_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	02	01	H3152_048_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											869.83	29						171.41	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	080	0	1	02	01	H3152_080_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	080	0	1	02	01	H3152_080_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3152_080_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	080	0	1	02	01	H3152_080_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	080	0	1	02	01	H3152_080_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	080	0	1	02	01	H3152_080_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	080	0	1	02	01	H3152_080_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											741.32	28						347.41	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	082	0	1	01	01	H3152_082_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	082	0	1	01	01	H3152_082_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	082	0	1	01	01	H3152_082_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	082	0	1	01	01	H3152_082_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	082	0	1	01	01	H3152_082_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	082	0	1	01	01	H3152_082_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											874.15	27						529.23	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	084	0	1	01	01	H3152_084_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	084	0	1	01	01	H3152_084_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	084	0	1	01	01	H3152_084_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	084	0	1	01	01	H3152_084_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	084	0	1	01	01	H3152_084_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	084	0	1	01	01	H3152_084_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											717.60	28						444.71	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	088	0	1	01	01	H3152_088_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	088	0	1	01	01	H3152_088_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	088	0	1	01	01	H3152_088_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	088	0	1	01	01	H3152_088_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	088	0	1	01	01	H3152_088_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	088	0	1	01	01	H3152_088_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											641.50	27						481.98	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	092	0	1	01	01	H3152_092_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	092	0	1	01	01	H3152_092_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	092	0	1	01	01	H3152_092_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	092	0	1	01	01	H3152_092_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	092	0	1	01	01	H3152_092_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	092	0	1	01	01	H3152_092_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											915.36	27						323.14	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	7	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																			3.00	6.00	9.00																6.00				6.00		0.20			0.10			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	7	Generic	2	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																			9.00	18.00	27.00																18.00				18.00		0.60			0.30			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	7	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												
H3154	004	0	1	01	01	H3154_004_0	7	Non-Preferred Drug	2	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	70.00	140.00	210.00																			70.00	140.00	210.00																70.00				70.00		2.33			2.33			2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	7	Specialty Tier	2	11	1	1	5	1	010		01			1	30														30		31				498.35	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	7	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																			3.00	6.00	9.00																6.00				6.00		0.20			0.10			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	7	Generic	2	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																			9.00	18.00	27.00																18.00				18.00		0.60			0.30			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	7	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												
H3154	022	0	1	01	01	H3154_022_0	7	Non-Preferred Drug	2	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	70.00	140.00	210.00																			70.00	140.00	210.00																70.00				70.00		2.33			2.33			2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	7	Specialty Tier	2	11	1	1	5	1	010		01			1	30														30		31				352.27	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	030	0	1	01	01	H3154_030_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			2.00	4.00	6.00																4.00				4.00		0.13			0.07			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	030	0	1	01	01	H3154_030_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H3154	030	0	1	01	01	H3154_030_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H3154	030	0	1	01	01	H3154_030_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				51.78	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	030	0	1	01	01	H3154_030_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				551.17	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	031	0	1	01	01	H3154_031_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			2.00	4.00	6.00																4.00				4.00		0.13			0.07			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	031	0	1	01	01	H3154_031_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			5.00	10.00	15.00																10.00				10.00		0.33			0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	031	0	1	01	01	H3154_031_0	7	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												
H3154	031	0	1	01	01	H3154_031_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				54.28	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	031	0	1	01	01	H3154_031_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				514.71	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_032_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			2.00	4.00	6.00																4.00				4.00		0.13			0.07			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_032_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			5.00	10.00	15.00																10.00				10.00		0.33			0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_032_0	8	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												
H3154	032	0	1	01	01	H3154_032_0	8	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				48.51	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_032_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				715.01	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	1	1	01	01	H3170_003_1	5	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			4.00	8.00	0.00																3.00				3.00		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	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	0.00																8.00				8.00		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	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	37.00	74.00	111.00																			37.00	74.00	111.00																37.00				37.00		1.23			1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	1	1	01	01	H3170_003_1	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				928.12	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	2	1	01	01	H3170_003_2	5	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			4.00	8.00	0.00																3.00				3.00		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	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	0.00																8.00				8.00		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	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	37.00	74.00	111.00																			37.00	74.00	111.00																37.00				37.00		1.23			1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	2	1	01	01	H3170_003_2	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				928.12	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3186	001	0	1	04	01	H3186_001_0	12	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3186	001	0	1	04	01	H3186_001_0	12	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	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3186	001	0	1	04	01	H3186_001_0	12	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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												
H3186	001	0	1	04	01	H3186_001_0	12	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3186	001	0	1	04	01	H3186_001_0	12	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3186	002	0	1	04	01	H3186_002_0	12	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	5.00																			2.00	4.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3186	002	0	1	04	01	H3186_002_0	12	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	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3186	002	0	1	04	01	H3186_002_0	12	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	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												
H3186	002	0	1	04	01	H3186_002_0	12	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3186	002	0	1	04	01	H3186_002_0	12	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					28	28	28																		28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	001	0	1	02	01	H3192_001_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	001	0	1	02	01	H3192_001_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3192_001_0	6	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	001	0	1	02	01	H3192_001_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3192_001_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	001	0	1	02	01	H3192_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	001	0	1	02	01	H3192_001_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											748.81	33						457.50	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	002	0	1	02	01	H3192_002_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	002	0	1	02	01	H3192_002_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3192_002_0	6	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	002	0	1	02	01	H3192_002_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3192_002_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	002	0	1	02	01	H3192_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	002	0	1	02	01	H3192_002_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											906.24	33						475.33	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	003	0	1	02	01	H3192_003_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	003	0	1	02	01	H3192_003_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3192_003_0	6	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	003	0	1	02	01	H3192_003_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3192_003_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	003	0	1	02	01	H3192_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	003	0	1	02	01	H3192_003_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											885.85	33						499.10	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	004	0	1	02	01	H3192_004_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	004	0	1	02	01	H3192_004_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3192_004_0	6	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	004	0	1	02	01	H3192_004_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3192_004_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	004	0	1	02	01	H3192_004_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	004	0	1	02	01	H3192_004_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											987.74	33						402.57	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	005	0	1	02	01	H3192_005_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	005	0	1	02	01	H3192_005_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3192_005_0	6	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	005	0	1	02	01	H3192_005_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3192_005_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	005	0	1	02	01	H3192_005_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	005	0	1	02	01	H3192_005_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											969.55	33						422.06	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	006	0	1	02	01	H3192_006_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	006	0	1	02	01	H3192_006_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3192_006_0	5	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	006	0	1	02	01	H3192_006_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3192_006_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	006	0	1	02	01	H3192_006_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	006	0	1	02	01	H3192_006_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											944.47	33						450.60	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	007	0	1	01	01	H3192_007_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3192	007	0	1	01	01	H3192_007_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3192	007	0	1	01	01	H3192_007_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	007	0	1	01	01	H3192_007_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											42.65	25	25	25				39.99	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	007	0	1	01	01	H3192_007_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											583.00	25						378.60	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	008	0	1	01	01	H3192_008_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								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												
H3192	008	0	1	01	01	H3192_008_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3192	008	0	1	01	01	H3192_008_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	008	0	1	01	01	H3192_008_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											41.98	25	25	25				40.14	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	008	0	1	01	01	H3192_008_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											591.93	25						384.49	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	009	0	1	01	01	H3192_009_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3192	009	0	1	01	01	H3192_009_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3192	009	0	1	01	01	H3192_009_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	009	0	1	01	01	H3192_009_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											41.98	25	25	25				40.14	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	009	0	1	01	01	H3192_009_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											591.93	25						384.49	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	8	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	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	8	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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	8	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	8	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	8	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	8	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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	4	1	01	01	H3204_013_4	6	Preferred Generic	3	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												
H3204	013	4	1	01	01	H3204_013_4	6	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				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	4	1	01	01	H3204_013_4	6	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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	4	1	01	01	H3204_013_4	6	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				74.25	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	4	1	01	01	H3204_013_4	6	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	5	1	01	01	H3204_013_5	5	Preferred Generic	3	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												
H3204	013	5	1	01	01	H3204_013_5	5	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				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	5	1	01	01	H3204_013_5	5	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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	5	1	01	01	H3204_013_5	5	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				74.25	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	5	1	01	01	H3204_013_5	5	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	3	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	3	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	3	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	3	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	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												
H3213	015	0	1	01	01	H3213_015_0	5	Preferred Generic	4	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	5	Generic	4	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	5	Preferred Brand	4	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	5	Non-Preferred Drug	4	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	5	Specialty Tier	4	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	016	0	1	01	01	H3213_016_0	5	Preferred Generic	4	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												
H3213	016	0	1	01	01	H3213_016_0	5	Generic	4	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												
H3213	016	0	1	01	01	H3213_016_0	5	Preferred Brand	4	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												
H3213	016	0	1	01	01	H3213_016_0	5	Non-Preferred Drug	4	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												
H3213	016	0	1	01	01	H3213_016_0	5	Specialty Tier	4	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												
H3213	016	0	1	01	01	H3213_016_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3219	001	0	1	04	01	H3219_001_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	001	0	1	04	01	H3219_001_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	001	0	1	04	01	H3219_001_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	001	0	1	04	01	H3219_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	001	0	1	04	01	H3219_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	001	0	1	04	01	H3219_001_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											951.82	28						521.04	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	002	0	1	04	01	H3219_002_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	002	0	1	04	01	H3219_002_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	002	0	1	04	01	H3219_002_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	002	0	1	04	01	H3219_002_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	002	0	1	04	01	H3219_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	002	0	1	04	01	H3219_002_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1129.94	30						431.77	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	003	0	1	04	01	H3219_003_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	003	0	1	04	01	H3219_003_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	003	0	1	04	01	H3219_003_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	003	0	1	04	01	H3219_003_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	003	0	1	04	01	H3219_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	003	0	1	04	01	H3219_003_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1065.43	33						377.98	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	004	0	1	04	01	H3219_004_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	004	0	1	04	01	H3219_004_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	004	0	1	04	01	H3219_004_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	004	0	1	04	01	H3219_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	004	0	1	04	01	H3219_004_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1150.78	33						627.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3237	001	0	1	48	05	H3237_001_0	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	3.95	0.00	3.95	0.00	3.95	0.00	3.95			
H3237	001	0	1	48	05	H3237_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	9.85	0.00	9.85	0.00	9.85	0.00	9.85			
H3237	001	0	1	48	05	H3237_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3237	002	0	1	48	05	H3237_002_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	3.95	0.00	3.95	0.00	3.95	0.00	3.95			
H3237	002	0	1	48	05	H3237_002_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	9.85	0.00	9.85	0.00	9.85	0.00	9.85			
H3237	002	0	1	48	05	H3237_002_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3239	001	0	1	01	01	H3239_001_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3239	001	0	1	01	01	H3239_001_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3239	001	0	1	01	01	H3239_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	001	0	1	01	01	H3239_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											39.55	25	25	25				39.95	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	001	0	1	01	01	H3239_001_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											564.64	25						344.32	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	002	0	1	01	01	H3239_002_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3239	002	0	1	01	01	H3239_002_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3239	002	0	1	01	01	H3239_002_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	002	0	1	01	01	H3239_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											50.10	30	30	30				47.97	30	30	30										30	30	30				30	30	30				30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	002	0	1	01	01	H3239_002_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											587.06	25						380.90	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	003	0	1	01	01	H3239_003_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3239	003	0	1	01	01	H3239_003_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3239	003	0	1	01	01	H3239_003_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	003	0	1	01	01	H3239_003_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											40.93	25	25	25				39.46	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	003	0	1	01	01	H3239_003_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											587.42	25						383.53	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	005	0	1	01	01	H3239_005_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3239	005	0	1	01	01	H3239_005_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3239	005	0	1	01	01	H3239_005_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	005	0	1	01	01	H3239_005_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											41.17	25	25	25				39.51	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	005	0	1	01	01	H3239_005_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											582.90	25						378.82	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	006	0	1	01	01	H3239_006_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								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												
H3239	006	0	1	01	01	H3239_006_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3239	006	0	1	01	01	H3239_006_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	006	0	1	01	01	H3239_006_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											41.48	25	25	25				38.75	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	006	0	1	01	01	H3239_006_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											561.17	25						360.21	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	007	0	1	01	01	H3239_007_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3239	007	0	1	01	01	H3239_007_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3239	007	0	1	01	01	H3239_007_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	007	0	1	01	01	H3239_007_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											41.48	25	25	25				38.75	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	007	0	1	01	01	H3239_007_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											561.17	25						360.21	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	008	0	1	01	01	H3239_008_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3239	008	0	1	01	01	H3239_008_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3239	008	0	1	01	01	H3239_008_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	008	0	1	01	01	H3239_008_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											41.52	25	25	25				39.69	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	008	0	1	01	01	H3239_008_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											585.24	25						380.20	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3240	013	0	1	01	01	H3240_013_0	6	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	6	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	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	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	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	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	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	9	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	9	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	9	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	9	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	9	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	8	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	8	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	8	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					0.00	0.00	0.00																13.00				13.00			0.43	0.43	0.00			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	8	Preferred Brand	4	11	1	2	3	1		111	01	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	8	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3240	022	0	1	01	01	H3240_022_0	6	Preferred Generic	4	01	3	2	1	1		111	01	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												
H3240	022	0	1	01	01	H3240_022_0	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	022	0	1	01	01	H3240_022_0	6	Preferred Brand	4	11	1	2	3	1		111	01	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	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	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	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	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	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	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	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	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	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	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	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H3251	002	0	1	01	01	H3251_002_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H3251	002	0	1	01	01	H3251_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_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												
H3274	002	0	1	01	01	H3274_002_0	6	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	6.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3274	002	0	1	01	01	H3274_002_0	6	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			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												
H3274	002	0	1	01	01	H3274_002_0	6	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												
H3274	002	0	1	01	01	H3274_002_0	6	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												
H3274	002	0	1	01	01	H3274_002_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				797.12	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3274	003	0	1	01	01	H3274_003_0	6	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	6.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3274	003	0	1	01	01	H3274_003_0	6	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			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												
H3274	003	0	1	01	01	H3274_003_0	6	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												
H3274	003	0	1	01	01	H3274_003_0	6	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												
H3274	003	0	1	01	01	H3274_003_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				797.12	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3281	001	0	1	04	01	H3281_001_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H3281	001	0	1	04	01	H3281_001_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H3281	001	0	1	04	01	H3281_001_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		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	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				701.66	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	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H3281	010	0	1	04	01	H3281_010_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0.00		0.00																					0																0				0		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	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H3281	010	0	1	04	01	H3281_010_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	0.00		0.00																					0																0				0		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	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47.00		141.00																					94																47				47		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	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100.00		300.00																					200																100				100		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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				538.93	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	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0.00		0.00																					0																0				0		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	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H3288	001	0	1	04	01	H3288_001_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	001	0	1	04	01	H3288_001_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	001	0	1	04	01	H3288_001_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	001	0	1	04	01	H3288_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	001	0	1	04	01	H3288_001_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											880.48	28						296.14	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	002	0	1	04	01	H3288_002_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	002	0	1	04	01	H3288_002_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	002	0	1	04	01	H3288_002_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	002	0	1	04	01	H3288_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	002	0	1	04	01	H3288_002_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1233.38	29						688.43	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	003	0	1	04	01	H3288_003_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	003	0	1	04	01	H3288_003_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	003	0	1	04	01	H3288_003_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	003	0	1	04	01	H3288_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	003	0	1	04	01	H3288_003_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											783.74	28						242.42	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	004	0	1	04	01	H3288_004_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	004	0	1	04	01	H3288_004_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	004	0	1	04	01	H3288_004_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	004	0	1	04	01	H3288_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	004	0	1	04	01	H3288_004_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											839.40	28						211.68	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	005	0	1	04	01	H3288_005_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	005	0	1	04	01	H3288_005_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	005	0	1	04	01	H3288_005_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	005	0	1	04	01	H3288_005_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	005	0	1	04	01	H3288_005_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											896.74	29						474.97	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	006	0	1	04	01	H3288_006_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	006	0	1	04	01	H3288_006_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	006	0	1	04	01	H3288_006_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	006	0	1	04	01	H3288_006_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	006	0	1	04	01	H3288_006_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											760.33	28						267.20	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	007	0	1	04	01	H3288_007_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	007	0	1	04	01	H3288_007_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	007	0	1	04	01	H3288_007_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	007	0	1	04	01	H3288_007_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	007	0	1	04	01	H3288_007_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											789.83	28						444.29	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	008	0	1	04	01	H3288_008_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	008	0	1	04	01	H3288_008_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	008	0	1	04	01	H3288_008_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	008	0	1	04	01	H3288_008_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	008	0	1	04	01	H3288_008_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											931.82	29						477.56	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	009	0	1	04	01	H3288_009_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	009	0	1	04	01	H3288_009_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	009	0	1	04	01	H3288_009_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	009	0	1	04	01	H3288_009_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	009	0	1	04	01	H3288_009_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											850.46	29						502.10	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	010	0	1	04	01	H3288_010_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	010	0	1	04	01	H3288_010_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	010	0	1	04	01	H3288_010_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	010	0	1	04	01	H3288_010_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	010	0	1	04	01	H3288_010_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											905.50	28						632.15	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	011	0	1	04	01	H3288_011_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	011	0	1	04	01	H3288_011_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	011	0	1	04	01	H3288_011_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	011	0	1	04	01	H3288_011_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	011	0	1	04	01	H3288_011_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											887.43	29						452.70	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	012	0	1	04	01	H3288_012_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	012	0	1	04	01	H3288_012_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	012	0	1	04	01	H3288_012_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	012	0	1	04	01	H3288_012_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	012	0	1	04	01	H3288_012_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											733.21	28						416.77	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	013	0	1	04	01	H3288_013_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	013	0	1	04	01	H3288_013_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	013	0	1	04	01	H3288_013_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	013	0	1	04	01	H3288_013_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	013	0	1	04	01	H3288_013_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1099.80	28						378.51	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	015	0	1	04	01	H3288_015_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	015	0	1	04	01	H3288_015_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	015	0	1	04	01	H3288_015_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	015	0	1	04	01	H3288_015_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	015	0	1	04	01	H3288_015_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											765.13	28						292.30	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	016	0	1	04	01	H3288_016_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	016	0	1	04	01	H3288_016_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	016	0	1	04	01	H3288_016_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	016	0	1	04	01	H3288_016_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	016	0	1	04	01	H3288_016_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											923.64	28						314.58	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	017	0	1	04	01	H3288_017_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	017	0	1	04	01	H3288_017_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	017	0	1	04	01	H3288_017_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	017	0	1	04	01	H3288_017_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	017	0	1	04	01	H3288_017_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											734.04	29						382.36	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	018	0	1	04	01	H3288_018_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	018	0	1	04	01	H3288_018_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	018	0	1	04	01	H3288_018_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	018	0	1	04	01	H3288_018_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	018	0	1	04	01	H3288_018_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											806.80	29						419.95	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	019	0	1	04	01	H3288_019_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	019	0	1	04	01	H3288_019_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	019	0	1	04	01	H3288_019_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	019	0	1	04	01	H3288_019_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	019	0	1	04	01	H3288_019_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											738.25	29						415.14	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	020	0	1	04	01	H3288_020_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	020	0	1	04	01	H3288_020_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	020	0	1	04	01	H3288_020_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	020	0	1	04	01	H3288_020_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	020	0	1	04	01	H3288_020_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											752.86	29						622.02	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	021	0	1	04	01	H3288_021_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	021	0	1	04	01	H3288_021_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	021	0	1	04	01	H3288_021_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	021	0	1	04	01	H3288_021_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	021	0	1	04	01	H3288_021_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											796.35	28						397.44	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	022	0	1	04	01	H3288_022_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	022	0	1	04	01	H3288_022_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	022	0	1	04	01	H3288_022_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	022	0	1	04	01	H3288_022_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	022	0	1	04	01	H3288_022_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											931.92	28						341.18	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	023	0	1	04	01	H3288_023_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	023	0	1	04	01	H3288_023_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	023	0	1	04	01	H3288_023_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	023	0	1	04	01	H3288_023_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	023	0	1	04	01	H3288_023_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1059.37	30						566.21	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	024	0	1	04	01	H3288_024_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	024	0	1	04	01	H3288_024_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	024	0	1	04	01	H3288_024_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	024	0	1	04	01	H3288_024_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	024	0	1	04	01	H3288_024_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	024	0	1	04	01	H3288_024_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											899.71	30						432.99	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	025	0	1	04	01	H3288_025_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	025	0	1	04	01	H3288_025_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	025	0	1	04	01	H3288_025_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	025	0	1	04	01	H3288_025_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	025	0	1	04	01	H3288_025_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	025	0	1	04	01	H3288_025_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1052.46	30						501.85	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	026	0	1	04	01	H3288_026_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	026	0	1	04	01	H3288_026_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	026	0	1	04	01	H3288_026_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	026	0	1	04	01	H3288_026_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	026	0	1	04	01	H3288_026_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											815.72	30						434.51	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	027	0	1	04	01	H3288_027_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	027	0	1	04	01	H3288_027_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	027	0	1	04	01	H3288_027_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	027	0	1	04	01	H3288_027_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	027	0	1	04	01	H3288_027_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	027	0	1	04	01	H3288_027_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											900.93	30						474.35	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	028	0	1	04	01	H3288_028_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	028	0	1	04	01	H3288_028_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	028	0	1	04	01	H3288_028_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	028	0	1	04	01	H3288_028_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	028	0	1	04	01	H3288_028_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	028	0	1	04	01	H3288_028_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1021.71	30						638.90	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	029	0	1	04	01	H3288_029_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	029	0	1	04	01	H3288_029_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	029	0	1	04	01	H3288_029_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	029	0	1	04	01	H3288_029_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	029	0	1	04	01	H3288_029_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	029	0	1	04	01	H3288_029_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1071.03	30						468.16	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	030	0	1	04	01	H3288_030_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	030	0	1	04	01	H3288_030_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	030	0	1	04	01	H3288_030_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	030	0	1	04	01	H3288_030_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	030	0	1	04	01	H3288_030_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	030	0	1	04	01	H3288_030_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1021.87	30						642.49	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	031	0	1	04	01	H3288_031_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	031	0	1	04	01	H3288_031_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	031	0	1	04	01	H3288_031_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	031	0	1	04	01	H3288_031_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	031	0	1	04	01	H3288_031_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	031	0	1	04	01	H3288_031_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											877.44	30						475.63	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	032	0	1	04	01	H3288_032_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	032	0	1	04	01	H3288_032_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	032	0	1	04	01	H3288_032_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	032	0	1	04	01	H3288_032_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	032	0	1	04	01	H3288_032_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	032	0	1	04	01	H3288_032_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1363.14	30						619.49	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	033	0	1	04	01	H3288_033_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	033	0	1	04	01	H3288_033_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	033	0	1	04	01	H3288_033_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	033	0	1	04	01	H3288_033_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	033	0	1	04	01	H3288_033_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	033	0	1	04	01	H3288_033_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											990.46	30						756.46	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	035	0	1	04	01	H3288_035_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	035	0	1	04	01	H3288_035_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	035	0	1	04	01	H3288_035_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	035	0	1	04	01	H3288_035_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	035	0	1	04	01	H3288_035_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											844.69	30						488.84	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	036	0	1	04	01	H3288_036_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	036	0	1	04	01	H3288_036_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	036	0	1	04	01	H3288_036_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	036	0	1	04	01	H3288_036_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	036	0	1	04	01	H3288_036_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											961.26	30						498.07	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	037	0	1	04	01	H3288_037_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	037	0	1	04	01	H3288_037_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	037	0	1	04	01	H3288_037_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	037	0	1	04	01	H3288_037_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	037	0	1	04	01	H3288_037_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											908.17	30						455.33	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	038	0	1	04	01	H3288_038_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	038	0	1	04	01	H3288_038_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	038	0	1	04	01	H3288_038_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	038	0	1	04	01	H3288_038_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	038	0	1	04	01	H3288_038_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											874.38	30						472.97	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	039	0	1	04	01	H3288_039_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	039	0	1	04	01	H3288_039_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	039	0	1	04	01	H3288_039_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	039	0	1	04	01	H3288_039_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	039	0	1	04	01	H3288_039_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											819.18	30						303.05	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	040	0	1	04	01	H3288_040_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	040	0	1	04	01	H3288_040_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	040	0	1	04	01	H3288_040_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	040	0	1	04	01	H3288_040_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	040	0	1	04	01	H3288_040_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											917.29	30						482.84	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	041	0	1	04	01	H3288_041_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	041	0	1	04	01	H3288_041_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	041	0	1	04	01	H3288_041_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	041	0	1	04	01	H3288_041_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	041	0	1	04	01	H3288_041_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											856.73	30						452.02	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	042	0	1	04	01	H3288_042_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	042	0	1	04	01	H3288_042_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	042	0	1	04	01	H3288_042_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	042	0	1	04	01	H3288_042_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	042	0	1	04	01	H3288_042_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											935.73	30						491.01	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	043	0	1	04	01	H3288_043_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	043	0	1	04	01	H3288_043_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	043	0	1	04	01	H3288_043_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	043	0	1	04	01	H3288_043_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	043	0	1	04	01	H3288_043_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											871.59	30						380.40	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	044	0	1	04	01	H3288_044_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	044	0	1	04	01	H3288_044_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	044	0	1	04	01	H3288_044_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	044	0	1	04	01	H3288_044_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	044	0	1	04	01	H3288_044_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											816.78	30						548.76	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	045	0	1	04	01	H3288_045_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	045	0	1	04	01	H3288_045_0	4	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					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												
H3288	045	0	1	04	01	H3288_045_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	045	0	1	04	01	H3288_045_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	045	0	1	04	01	H3288_045_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											845.06	26						467.24	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	046	0	1	04	01	H3288_046_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	046	0	1	04	01	H3288_046_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	046	0	1	04	01	H3288_046_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	046	0	1	04	01	H3288_046_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	046	0	1	04	01	H3288_046_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1016.62	28						352.48	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	047	0	1	04	01	H3288_047_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	047	0	1	04	01	H3288_047_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	047	0	1	04	01	H3288_047_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	047	0	1	04	01	H3288_047_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	047	0	1	04	01	H3288_047_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											651.94	29						493.87	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	048	0	1	04	01	H3288_048_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	048	0	1	04	01	H3288_048_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	048	0	1	04	01	H3288_048_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	048	0	1	04	01	H3288_048_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	048	0	1	04	01	H3288_048_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											860.61	28						339.22	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	003	0	1	01	01	H3293_003_0	8	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				2	2			90				30		31	4.00		12.00																					12.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3293	003	0	1	01	01	H3293_003_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	15.00		45.00																					45.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3293	003	0	1	01	01	H3293_003_0	8	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, Select Care Drugs												
H3293	003	0	1	01	01	H3293_003_0	8	Non-Preferred 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												
H3293	003	0	1	01	01	H3293_003_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				984.13	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3293	003	0	1	01	01	H3293_003_0	8	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	4.00		12.00																					12.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3293	004	0	1	01	01	H3293_004_0	8	Preferred Generic	4	01	3	1	1	1	110		01	100		1	30		90				2	2			90				30		31				.66	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3293	004	0	1	01	01	H3293_004_0	8	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				7.33	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3293	004	0	1	01	01	H3293_004_0	8	Preferred Brand	4	10	3	1	3	1	110		01	100		1	30		90				2	2			90				30		31				85.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3293	004	0	1	01	01	H3293_004_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				111.66	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3293	004	0	1	01	01	H3293_004_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				607.34	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3293	004	0	1	01	01	H3293_004_0	8	Select Care Drugs	4	01	1	1	6	1	110		01	100		1	30		90				2	2			90				30		31				.01	15		15																				15															15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3293	005	0	1	01	01	H3293_005_0	7	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, Select Care Drugs												
H3293	005	0	1	01	01	H3293_005_0	7	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, Select Care Drugs										1		1
H3293	005	0	1	01	01	H3293_005_0	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3293	005	0	1	01	01	H3293_005_0	7	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3293	005	0	1	01	01	H3293_005_0	7	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, Select Care Drugs												
H3293	005	0	1	01	01	H3293_005_0	7	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, Select Care Drugs												
H3293	005	0	1	01	01	H3293_005_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				945.33	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3293	005	0	1	01	01	H3293_005_0	7	Select Care Drugs	4	01	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												
H3293	005	0	1	01	01	H3293_005_0	7	Select Care Drugs	4	01	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		
H3305	015	0	1	02	01	H3305_015_0	8	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_0	8	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3305	015	0	1	02	01	H3305_015_0	8	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		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	8	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	40.00		120.00																			40.00		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	8	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	8	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	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_0	7	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3305	021	0	1	02	01	H3305_021_0	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_0	7	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				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	7	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	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	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	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	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	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	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	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	030	0	1	02	01	H3305_030_0	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	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	030	0	1	02	01	H3305_030_0	7	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	030	0	1	02	01	H3305_030_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				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	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	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	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	Preferred Brand	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	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				99.27	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	032	0	1	02	01	H3305_032_0	6	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	4	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		
H3307	002	0	1	01	01	H3307_002_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3307	002	0	1	01	01	H3307_002_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				276.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	2	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		
H3307	012	0	1	01	01	H3307_012_0	2	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	2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				247.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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		
H3307	015	0	1	01	01	H3307_015_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3307	015	0	1	01	01	H3307_015_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				294.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				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												
H3307	023	0	1	01	01	H3307_023_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3307	023	0	1	01	01	H3307_023_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3307	023	0	1	01	01	H3307_023_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				236.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	2	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3307	025	0	1	01	01	H3307_025_0	2	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	2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				306.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											801.37	28						488.56	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	018	0	1	01	01	H3312_018_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1011.05	28						322.58	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	048	0	1	01	01	H3312_048_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	048	0	1	01	01	H3312_048_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1002.97	33						593.81	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	062	0	1	02	01	H3312_062_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	062	0	1	02	01	H3312_062_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3312_062_0	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	062	0	1	02	01	H3312_062_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3312_062_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	062	0	1	02	01	H3312_062_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	062	0	1	02	01	H3312_062_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											868.73	28						442.86	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	064	0	1	01	01	H3312_064_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	064	0	1	01	01	H3312_064_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	064	0	1	01	01	H3312_064_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	064	0	1	01	01	H3312_064_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	064	0	1	01	01	H3312_064_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	064	0	1	01	01	H3312_064_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											849.59	28						318.97	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	065	0	1	02	01	H3312_065_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	065	0	1	02	01	H3312_065_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3312_065_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	065	0	1	02	01	H3312_065_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3312_065_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	065	0	1	02	01	H3312_065_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	065	0	1	02	01	H3312_065_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											870.67	28						485.11	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	068	0	1	01	01	H3312_068_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	068	0	1	01	01	H3312_068_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	068	0	1	01	01	H3312_068_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	068	0	1	01	01	H3312_068_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	068	0	1	01	01	H3312_068_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	068	0	1	01	01	H3312_068_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											816.89	28						256.20	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	069	0	1	01	01	H3312_069_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3312	069	0	1	01	01	H3312_069_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3312	069	0	1	01	01	H3312_069_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	069	0	1	01	01	H3312_069_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											44.94	25	25	25				42.06	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	069	0	1	01	01	H3312_069_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											636.99	26						413.79	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	070	0	1	01	01	H3312_070_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3312	070	0	1	01	01	H3312_070_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3312	070	0	1	01	01	H3312_070_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	070	0	1	01	01	H3312_070_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											44.83	25	25	25				42.04	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	070	0	1	01	01	H3312_070_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											611.34	25						397.15	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				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												
H3330	021	1	1	01	01	H3330_021_1	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H3330	021	1	1	01	01	H3330_021_1	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3330	021	1	1	01	01	H3330_021_1	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				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												
H3330	021	1	1	01	01	H3330_021_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				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												
H3330	021	2	1	01	01	H3330_021_2	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H3330	021	2	1	01	01	H3330_021_2	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3330	021	2	1	01	01	H3330_021_2	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				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												
H3330	021	2	1	01	01	H3330_021_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				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												
H3330	021	3	1	01	01	H3330_021_3	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H3330	021	3	1	01	01	H3330_021_3	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3330	021	3	1	01	01	H3330_021_3	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H3330	021	3	1	01	01	H3330_021_3	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				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												
H3330	021	4	1	01	01	H3330_021_4	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H3330	021	4	1	01	01	H3330_021_4	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3330	021	4	1	01	01	H3330_021_4	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	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												
H3330	021	4	1	01	01	H3330_021_4	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	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												
H3330	032	1	1	01	01	H3330_032_1	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.50		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				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												
H3330	032	2	1	01	01	H3330_032_2	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.50		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
H3330	032	2	1	01	01	H3330_032_2	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				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												
H3330	032	2	1	01	01	H3330_032_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				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												
H3330	032	3	1	01	01	H3330_032_3	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.50		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H3330	032	3	1	01	01	H3330_032_3	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	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												
H3330	032	4	1	01	01	H3330_032_4	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.50		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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												
H3330	036	0	1	01	01	H3330_036_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.50		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
H3330	036	0	1	01	01	H3330_036_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	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												
H3330	036	0	1	01	01	H3330_036_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	038	0	1	01	01	H3330_038_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				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												
H3330	038	0	1	01	01	H3330_038_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				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												
H3330	038	0	1	01	01	H3330_038_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3330	038	0	1	01	01	H3330_038_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				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												
H3330	038	0	1	01	01	H3330_038_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	1	1	01	01	H3330_039_1	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				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												
H3330	039	1	1	01	01	H3330_039_1	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.50		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	1	1	01	01	H3330_039_1	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	1	1	01	01	H3330_039_1	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				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												
H3330	039	1	1	01	01	H3330_039_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	2	1	01	01	H3330_039_2	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				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												
H3330	039	2	1	01	01	H3330_039_2	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.50		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	2	1	01	01	H3330_039_2	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
H3330	039	2	1	01	01	H3330_039_2	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				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												
H3330	039	2	1	01	01	H3330_039_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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				0.00			0.17	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	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	26.00					8.00	16.00	16.00											13.00	26.00	26.00				8.00	16.00	16.00				13.00				8.00			0.43	0.27		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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	33	33	33				1.00	33	33	33										33	33	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	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				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												
H3335	015	0	1	04	01	H3335_015_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	22.00					6.00	12.00	12.00											11.00	22.00	22.00				6.00	12.00	12.00				11.00				6.00			0.37	0.20		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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	33	33	33				1.00	33	33	33										33	33	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	6	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	34.00					12.00	24.00	24.00											17.00	34.00	34.00				12.00	24.00	24.00				17.00				12.00			0.57	0.40		0.57	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	6	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	40.00					15.00	30.00	30.00											20.00	40.00	40.00				15.00	30.00	30.00				20.00				15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	6	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	6	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.69	40	40	40				85.13	35	35	35										40	40	40				35	35	35			40			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	6	Specialty Tier	3	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	25	25	25				1.00	25	25	25										25	25	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	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				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												
H3335	038	0	1	04	01	H3335_038_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	26.00					8.00	16.00	16.00											13.00	26.00	26.00				8.00	16.00	16.00				13.00				8.00			0.43	0.27		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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	33	33	33				1.00	33	33	33										33	33	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	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				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												
H3335	053	0	1	04	01	H3335_053_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	30.00					10.00	20.00	20.00											15.00	30.00	30.00				10.00	20.00	20.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	6	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	30	30	30				1.00	30	30	30										30	30	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	055	0	1	04	01	H3335_055_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	16.00					3.00	6.00	6.00											8.00	16.00	16.00				3.00	6.00	6.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	055	0	1	04	01	H3335_055_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	34.00					12.00	24.00	24.00											17.00	34.00	34.00				12.00	24.00	24.00				17.00				12.00			0.57	0.40		0.57	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	055	0	1	04	01	H3335_055_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	055	0	1	04	01	H3335_055_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											76.65	30	30	30				69.46	28	28	28										30	30	30				28	28	28			30			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	055	0	1	04	01	H3335_055_0	6	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	27	27	27				1.00	27	27	27										27	27	27				27	27	27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3342	023	1	1	04	01	H3342_023_1	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	1	1	04	01	H3342_023_1	6	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	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	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	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	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	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	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	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	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	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	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	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	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	7	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	7	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		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				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	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				75.12	40		40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				993.79	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	010	0	1	04	01	H3344_010_0	7	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	7	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	7	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	7	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		1.50						1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	010	0	1	04	01	H3344_010_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				58.26	40		40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	010	0	1	04	01	H3344_010_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				1220.43	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	009	0	1	01	01	H3347_009_0	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				2	2			90				30		31				953.92	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	5	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	5	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	5	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	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				69.66	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	5	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				2	2			90				30		31				740.11	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	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				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												
H3351	002	0	1	02	01	H3351_002_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					5.00	10.00	10.00											10.00	20.00	20.00				5.00	10.00	10.00				10.00				5.00			0.33	0.17		0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	33	33	33				1.00	33	33	33										33	33	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	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				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												
H3351	006	0	1	02	01	H3351_006_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	34.00					12.00	24.00	24.00											17.00	34.00	34.00				12.00	24.00	24.00				17.00				12.00			0.57	0.40		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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	33	33	33				1.00	33	33	33										33	33	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	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				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												
H3351	010	0	1	01	01	H3351_010_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	30.00					10.00	20.00	20.00											15.00	30.00	30.00				10.00	20.00	20.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	33	33	33				1.00	33	33	33										33	33	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	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				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												
H3351	011	0	1	01	01	H3351_011_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	40.00					15.00	30.00	30.00											20.00	40.00	40.00				15.00	30.00	30.00				20.00				15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	29	29	29				1.00	29	29	29										29	29	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	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				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												
H3351	012	0	1	02	01	H3351_012_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	30.00					10.00	20.00	20.00											15.00	30.00	30.00				10.00	20.00	20.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	012	0	1	02	01	H3351_012_0	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	012	0	1	02	01	H3351_012_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	33	33	33				1.00	33	33	33										33	33	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	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				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												
H3351	013	0	1	02	01	H3351_013_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	40.00					15.00	30.00	30.00											20.00	40.00	40.00				15.00	30.00	30.00				20.00				15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	013	0	1	02	01	H3351_013_0	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	013	0	1	02	01	H3351_013_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	33	33	33				1.00	33	33	33										33	33	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	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					4.00	8.00	8.00											9.00	18.00	18.00				4.00	8.00	8.00				9.00				4.00			0.30	0.13		0.30	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	26.00					8.00	16.00	16.00											13.00	26.00	26.00				8.00	16.00	16.00				13.00				8.00			0.43	0.27		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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	90.00					40.00	80.00	80.00											45.00	90.00	90.00				40.00	80.00	80.00				45.00				40.00			1.50	1.33		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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	6	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	33	33	33				1.00	33	33	33										33	33	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	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				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												
H3351	016	0	1	01	01	H3351_016_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	40.00					15.00	30.00	30.00											20.00	40.00	40.00				15.00	30.00	30.00				20.00				15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	016	0	1	01	01	H3351_016_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	016	0	1	01	01	H3351_016_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	6	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	26	26	26				1.00	26	26	26										26	26	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	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				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												
H3351	017	0	1	01	01	H3351_017_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	38.00					14.00	28.00	28.00											19.00	38.00	38.00				14.00	28.00	28.00				19.00				14.00			0.63	0.47		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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	6	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	29	29	29				1.00	29	29	29										29	29	29				29	29	29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	018	0	1	02	01	H3351_018_0	7	Preferred Generic	4	01	1	2	1	1		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											5.00	10.00	10.00				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												
H3351	018	0	1	02	01	H3351_018_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	40.00					15.00	30.00	30.00											20.00	40.00	40.00				15.00	30.00	30.00				20.00				15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	018	0	1	02	01	H3351_018_0	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	018	0	1	02	01	H3351_018_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	28	28	28				1.00	28	28	28										28	28	28				28	28	28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	019	0	1	02	01	H3351_019_0	7	Preferred Generic	4	01	1	2	1	1		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											5.00	10.00	10.00				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												
H3351	019	0	1	02	01	H3351_019_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	38.00					14.00	28.00	28.00											19.00	38.00	38.00				14.00	28.00	28.00				19.00				14.00			0.63	0.47		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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	019	0	1	02	01	H3351_019_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	200.00					95.00	190.00	190.00											100.00	200.00	200.00				95.00	190.00	190.00				100.00				95.00			3.33	3.17		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	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	31	31	31				1.00	31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	020	0	1	01	01	H3351_020_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	16.00					3.00	6.00	6.00											8.00	16.00	16.00				3.00	6.00	6.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	020	0	1	01	01	H3351_020_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	34.00					12.00	24.00	24.00											17.00	34.00	34.00				12.00	24.00	24.00				17.00				12.00			0.57	0.40		0.57	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	020	0	1	01	01	H3351_020_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	94.00					42.00	84.00	84.00											47.00	94.00	94.00				42.00	84.00	84.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	020	0	1	01	01	H3351_020_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.60	28	28	28				63.24	28	28	28										28	28	28				28	28	28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	020	0	1	01	01	H3351_020_0	6	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1.00	27	27	27				1.00	27	27	27										27	27	27				27	27	27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	6	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, Supplemental Drugs												
H3359	001	0	1	01	01	H3359_001_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	10.00																			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, Supplemental Drugs												
H3359	001	0	1	01	01	H3359_001_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	47.00																			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, Supplemental Drugs												
H3359	001	0	1	01	01	H3359_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	001	0	1	01	01	H3359_001_0	6	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					26	26	26																		26	26	26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	001	0	1	01	01	H3359_001_0	6	Supplemental Drugs	4	01	2	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	10.00																			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, Supplemental Drugs												
H3359	001	0	1	01	01	H3359_001_0	6	Supplemental Drugs	4	01	2	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	10.00																			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, Supplemental Drugs										1		
H3359	019	0	1	01	01	H3359_019_0	6	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, Supplemental Drugs												
H3359	019	0	1	01	01	H3359_019_0	6	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	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	019	0	1	01	01	H3359_019_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	019	0	1	01	01	H3359_019_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				87.10	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	019	0	1	01	01	H3359_019_0	6	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				306.88	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	019	0	1	01	01	H3359_019_0	6	Supplemental Drugs	4	01	2	2	6	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, Supplemental Drugs												
H3359	019	0	1	01	01	H3359_019_0	6	Supplemental Drugs	4	01	2	2	6	3	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, Supplemental Drugs										1		
H3359	021	0	1	01	01	H3359_021_0	8	Preferred Generic	3	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												
H3359	021	0	1	01	01	H3359_021_0	8	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																			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												
H3359	021	0	1	01	01	H3359_021_0	8	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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												
H3359	021	0	1	01	01	H3359_021_0	8	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.20	42	42	42																		42	42	42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	021	0	1	01	01	H3359_021_0	8	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				320.57	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	034	0	1	01	01	H3359_034_0	6	Preferred Generic	3	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												
H3359	034	0	1	01	01	H3359_034_0	6	Generic	3	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												
H3359	034	0	1	01	01	H3359_034_0	6	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	034	0	1	01	01	H3359_034_0	6	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				44.86	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	034	0	1	01	01	H3359_034_0	6	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				333.98	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	038	0	1	01	01	H3359_038_0	7	Preferred Generic	3	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												
H3359	038	0	1	01	01	H3359_038_0	7	Generic	3	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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												
H3359	038	0	1	01	01	H3359_038_0	7	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	038	0	1	01	01	H3359_038_0	7	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				93.46	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	038	0	1	01	01	H3359_038_0	7	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				301.84	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	7	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	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	12.00		30.00																					30.00																12.00				12.00		0.40						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	7	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		1.40						1.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				67.19	43		43																				43															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				1212.88	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	8	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	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		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	8	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		34				62.58	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	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				28.77	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	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				352.02	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				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	9	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		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	9	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		1.40						1.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				81.65	46		46																				46															46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	9	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				954.24	31																																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	038	0	1	01	01	H3362_038_0	10	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	038	0	1	01	01	H3362_038_0	10	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		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	038	0	1	01	01	H3362_038_0	10	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	10	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				75.44	41		41																				41															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	038	0	1	01	01	H3362_038_0	10	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				944.94	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	039	0	1	01	01	H3362_039_0	11	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	3.00		7.50																					7.50																3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	039	0	1	01	01	H3362_039_0	11	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	039	0	1	01	01	H3362_039_0	11	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	039	0	1	01	01	H3362_039_0	11	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				89.93	41		41																				41															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	039	0	1	01	01	H3362_039_0	11	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				816.61	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	040	0	1	01	01	H3362_040_0	8	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	040	0	1	01	01	H3362_040_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	12.00		30.00																					30.00																12.00				12.00		0.40						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	040	0	1	01	01	H3362_040_0	8	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	040	0	1	01	01	H3362_040_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				99.01	38		38																				38															38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	040	0	1	01	01	H3362_040_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				1135.36	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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		
H3379	001	0	1	01	01	H3379_001_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3379	001	0	1	01	01	H3379_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	3	Specialty Tier	4	11	1	1	5	1	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												
H3379	039	0	1	01	01	H3379_039_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	3	Preferred Generic	4	01	1	2	1	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		
H3379	039	0	1	01	01	H3379_039_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				164.00	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	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												
H3379	040	0	1	01	01	H3379_040_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3379	040	0	1	01	01	H3379_040_0	3	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												
H3379	040	0	1	01	01	H3379_040_0	3	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
H3379	040	0	1	01	01	H3379_040_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	040	0	1	01	01	H3379_040_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	040	0	1	01	01	H3379_040_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				425.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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		
H3379	041	0	1	01	01	H3379_041_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	041	0	1	01	01	H3379_041_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3379	041	0	1	01	01	H3379_041_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	041	0	1	01	01	H3379_041_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	041	0	1	01	01	H3379_041_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				298.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		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	013	0	1	01	01	H3384_013_0	7	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					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	7	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					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	7	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								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	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6	Preferred Brand	4	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	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	6	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		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	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	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	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	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												30		30					30		30				30		30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	01	01	H3384_059_0	6	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		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	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	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	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	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	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	062	0	1	01	01	H3384_062_0	6	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								17.00		51.00					12.00		36.00					12.00		30.00																17.00				17.00			0.57	0.40	0.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	062	0	1	01	01	H3384_062_0	6	Preferred Brand	4	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	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	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	063	0	1	01	01	H3384_063_0	6	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		24.00					3.00		9.00					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												
H3384	063	0	1	01	01	H3384_063_0	6	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	063	0	1	01	01	H3384_063_0	6	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					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	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	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	067	0	1	01	01	H3384_067_0	6	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								9.00		27.00					4.00		12.00					4.00		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	067	0	1	01	01	H3384_067_0	6	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								17.00		51.00					12.00		36.00					12.00		30.00																17.00				17.00			0.57	0.40	0.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	067	0	1	01	01	H3384_067_0	6	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					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	067	0	1	01	01	H3384_067_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	067	0	1	01	01	H3384_067_0	6	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												27		27					27		27				27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	8	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	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	8	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	22.00	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	8	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	80.00	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	8	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	90.00	180.00	270.00																									90.00	180.00	270.00				90.00	180.00	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	8	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	9	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	2.00	4.00	6.00																									2.00	4.00	6.00				0.00	0.00	0.00				2.00				2.00		0.07				0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	9	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	13.00	26.00	39.00																									13.00	26.00	39.00				13.00	26.00	26.00				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	9	Preferred Brand	4	11	1	2	3	1	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	84.00	84.00				42.00				42.00		1.40				1.40	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	93.00	186.00	279.00																									93.00	186.00	279.00				93.00	186.00	232.50				93.00				93.00		3.10				3.10	3.10	3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	9	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				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	6	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	3.00	6.00	9.00																									3.00	6.00	9.00				0.00	0.00	0.00				3.00				3.00		0.10				0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	6	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	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	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	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	6	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	97.00	194.00	291.00																									97.00	194.00	291.00				97.00	194.00	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	6	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	6	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	3.00	6.00	9.00																									3.00	6.00	9.00				0.00	0.00	0.00				3.00				3.00		0.10				0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	014	0	1	01	01	H3388_014_0	6	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	17.00	34.00	51.00																									17.00	34.00	51.00				17.00	34.00	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	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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												
H3388	014	0	1	01	01	H3388_014_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		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												
H3388	014	0	1	01	01	H3388_014_0	6	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	6	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	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	6	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	6	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	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				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	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				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	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	7	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	7	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3416	001	6	1	04	01	H3416_001_6	8	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	6	1	04	01	H3416_001_6	8	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	6	1	04	01	H3416_001_6	8	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		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	8	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		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	8	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	7	1	04	01	H3416_001_7	8	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	7	1	04	01	H3416_001_7	8	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	7	1	04	01	H3416_001_7	8	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		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	8	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		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	8	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	7	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	7	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3416	002	4	1	04	01	H3416_002_4	7	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	7	Generic	4	01	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		
H3416	002	4	1	04	01	H3416_002_4	7	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	7	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	5	1	04	01	H3416_002_5	8	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	5	1	04	01	H3416_002_5	8	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3416	002	5	1	04	01	H3416_002_5	8	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	5	1	04	01	H3416_002_5	8	Generic	4	01	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		
H3416	002	5	1	04	01	H3416_002_5	8	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		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	8	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		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	8	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3418	001	0	1	04	01	H3418_001_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3418	001	0	1	04	01	H3418_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	3	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												
H3418	002	0	1	04	01	H3418_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	002	0	1	04	01	H3418_002_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3418	002	0	1	04	01	H3418_002_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	002	0	1	04	01	H3418_002_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3418	002	0	1	04	01	H3418_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	002	0	1	04	01	H3418_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	002	0	1	04	01	H3418_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				247.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3419	002	0	1	01	01	H3419_002_0	7	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	6.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3419	002	0	1	01	01	H3419_002_0	7	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												
H3419	002	0	1	01	01	H3419_002_0	7	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												
H3419	002	0	1	01	01	H3419_002_0	7	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												
H3419	002	0	1	01	01	H3419_002_0	7	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				797.12	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3442	001	0	1	04	01	H3442_001_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	001	0	1	04	01	H3442_001_0	3	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											422.00	33						391.00	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	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	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		
H3442	003	0	1	04	01	H3442_003_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											405.00	29						204.00	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	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	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		
H3442	004	0	1	04	01	H3442_004_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											467.00	33						439.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	006	0	1	04	01	H3442_006_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	006	0	1	04	01	H3442_006_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3442	006	0	1	04	01	H3442_006_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		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												
H3442	006	0	1	04	01	H3442_006_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		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										2		2
H3442	006	0	1	04	01	H3442_006_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	006	0	1	04	01	H3442_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	006	0	1	04	01	H3442_006_0	3	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												
H3442	007	0	1	04	01	H3442_007_0	3	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	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		
H3442	007	0	1	04	01	H3442_007_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											231.00	29						419.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	010	0	1	04	01	H3442_010_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	010	0	1	04	01	H3442_010_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3442	010	0	1	04	01	H3442_010_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	010	0	1	04	01	H3442_010_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3442	010	0	1	04	01	H3442_010_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	010	0	1	04	01	H3442_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	010	0	1	04	01	H3442_010_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				533.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3443	001	0	1	01	01	H3443_001_0	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	001	0	1	01	01	H3443_001_0	6	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	001	0	1	01	01	H3443_001_0	6	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	001	0	1	01	01	H3443_001_0	6	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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	001	0	1	01	01	H3443_001_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				933.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	001	0	1	01	01	H3443_001_0	6	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	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, Select Care Drugs												
H3443	001	0	1	01	01	H3443_001_0	6	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	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, Select Care Drugs										1		
H3443	002	0	1	01	01	H3443_002_0	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	002	0	1	01	01	H3443_002_0	6	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	002	0	1	01	01	H3443_002_0	6	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	002	0	1	01	01	H3443_002_0	6	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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	002	0	1	01	01	H3443_002_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				935.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	002	0	1	01	01	H3443_002_0	6	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	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, Select Care Drugs												
H3443	002	0	1	01	01	H3443_002_0	6	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	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, Select Care Drugs										1		
H3443	003	0	1	01	01	H3443_003_0	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	003	0	1	01	01	H3443_003_0	6	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	003	0	1	01	01	H3443_003_0	6	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	003	0	1	01	01	H3443_003_0	6	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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	003	0	1	01	01	H3443_003_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				872.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	003	0	1	01	01	H3443_003_0	6	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	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, Select Care Drugs												
H3443	003	0	1	01	01	H3443_003_0	6	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	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, Select Care Drugs										1		
H3447	001	0	1	01	01	H3447_001_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	6	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	6	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	6	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	001	0	1	01	01	H3447_001_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	6	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	6	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	6	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	6	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	6	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					0.00	0.00	0.00																14.50				14.50			0.48	0.32	0.00			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	003	0	1	01	01	H3447_003_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	6	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	6	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	6	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	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	004	0	1	01	01	H3447_004_0	6	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	6	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H3447	004	0	1	01	01	H3447_004_0	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	6	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	6	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	6	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					0.00	0.00	0.00																17.50				17.50			0.58	0.42	0.00			0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	6	Preferred Brand	4	11	1	2	3	1		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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	6	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	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	010	0	1	01	01	H3447_010_0	6	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	6	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	6	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	6	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	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	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												
H3447	011	0	1	01	01	H3447_011_0	6	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												
H3447	011	0	1	01	01	H3447_011_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								40.00	80.00	120.00					40.00	80.00	120.00					40.00	120.00	120.00																40.00				40.00			1.33	1.33	1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				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	013	0	1	01	01	H3447_013_0	7	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					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												
H3447	013	0	1	01	01	H3447_013_0	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	013	0	1	01	01	H3447_013_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	013	0	1	01	01	H3447_013_0	7	Preferred Brand	4	11	1	2	3	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H3447	013	0	1	01	01	H3447_013_0	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	013	0	1	01	01	H3447_013_0	7	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	7	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	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					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												
H3447	014	0	1	01	01	H3447_014_0	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	014	0	1	01	01	H3447_014_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	014	0	1	01	01	H3447_014_0	6	Preferred Brand	4	11	1	2	3	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H3447	014	0	1	01	01	H3447_014_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	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	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	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					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												
H3447	018	0	1	01	01	H3447_018_0	7	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												
H3447	018	0	1	01	01	H3447_018_0	7	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	120.00					40.00	120.00	120.00																40.00				40.00			1.33	1.33	1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				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												
H3447	020	0	1	01	01	H3447_020_0	10	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					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	020	0	1	01	01	H3447_020_0	10	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												
H3447	020	0	1	01	01	H3447_020_0	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	020	0	1	01	01	H3447_020_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	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	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	022	0	1	01	01	H3447_022_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					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	7	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					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	022	0	1	01	01	H3447_022_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	022	0	1	01	01	H3447_022_0	7	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	7	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	024	0	1	01	01	H3447_024_0	7	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					0.00	0.00	0.00																9.00				9.00			0.30	0.30	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	7	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	7	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	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					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												
H3447	025	0	1	01	01	H3447_025_0	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			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	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	105.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	025	0	1	01	01	H3447_025_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	105.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H3447	025	0	1	01	01	H3447_025_0	7	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	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	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	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	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	026	0	1	01	01	H3447_026_0	8	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	8	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	026	0	1	01	01	H3447_026_0	8	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	8	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	8	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	8	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	8	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	8	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	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	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	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					0.00	0.00	0.00																16.00				16.00			0.53	0.53	0.00			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	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	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	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	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	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	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	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	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					0.00	0.00	0.00																10.00				10.00			0.33	0.33	0.00			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	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	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	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	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					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												
H3447	030	0	1	01	01	H3447_030_0	7	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												
H3447	030	0	1	01	01	H3447_030_0	7	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	120.00					40.00	120.00	120.00																40.00				40.00			1.33	1.33	1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	030	0	1	01	01	H3447_030_0	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	030	0	1	01	01	H3447_030_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				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												
H3447	033	0	1	01	01	H3447_033_0	11	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					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												
H3447	033	0	1	01	01	H3447_033_0	11	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	033	0	1	01	01	H3447_033_0	11	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	033	0	1	01	01	H3447_033_0	11	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	033	0	1	01	01	H3447_033_0	11	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	033	0	1	01	01	H3447_033_0	11	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	033	0	1	01	01	H3447_033_0	11	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	035	1	1	01	01	H3447_035_1	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					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	035	1	1	01	01	H3447_035_1	7	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					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	035	1	1	01	01	H3447_035_1	7	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	035	1	1	01	01	H3447_035_1	7	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	035	1	1	01	01	H3447_035_1	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	035	1	1	01	01	H3447_035_1	7	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	035	1	1	01	01	H3447_035_1	7	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	035	2	1	01	01	H3447_035_2	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					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	035	2	1	01	01	H3447_035_2	7	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					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	035	2	1	01	01	H3447_035_2	7	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	035	2	1	01	01	H3447_035_2	7	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	035	2	1	01	01	H3447_035_2	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	035	2	1	01	01	H3447_035_2	7	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	035	2	1	01	01	H3447_035_2	7	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	036	1	1	01	01	H3447_036_1	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					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	036	1	1	01	01	H3447_036_1	7	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					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	036	1	1	01	01	H3447_036_1	7	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	036	1	1	01	01	H3447_036_1	7	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	036	1	1	01	01	H3447_036_1	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	036	1	1	01	01	H3447_036_1	7	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	036	1	1	01	01	H3447_036_1	7	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	036	2	1	01	01	H3447_036_2	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					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	036	2	1	01	01	H3447_036_2	7	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					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	036	2	1	01	01	H3447_036_2	7	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	036	2	1	01	01	H3447_036_2	7	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	036	2	1	01	01	H3447_036_2	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	036	2	1	01	01	H3447_036_2	7	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	036	2	1	01	01	H3447_036_2	7	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	037	0	1	01	01	H3447_037_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	037	0	1	01	01	H3447_037_0	6	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	037	0	1	01	01	H3447_037_0	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	037	0	1	01	01	H3447_037_0	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	037	0	1	01	01	H3447_037_0	6	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	037	0	1	01	01	H3447_037_0	6	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H3447	037	0	1	01	01	H3447_037_0	6	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	037	0	1	01	01	H3447_037_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	037	0	1	01	01	H3447_037_0	6	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	037	0	1	01	01	H3447_037_0	6	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	038	1	1	01	01	H3447_038_1	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	038	1	1	01	01	H3447_038_1	7	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	038	1	1	01	01	H3447_038_1	7	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	038	1	1	01	01	H3447_038_1	7	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	038	1	1	01	01	H3447_038_1	7	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	038	1	1	01	01	H3447_038_1	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	038	1	1	01	01	H3447_038_1	7	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	038	1	1	01	01	H3447_038_1	7	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	038	2	1	01	01	H3447_038_2	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	038	2	1	01	01	H3447_038_2	7	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	038	2	1	01	01	H3447_038_2	7	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	038	2	1	01	01	H3447_038_2	7	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	038	2	1	01	01	H3447_038_2	7	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	038	2	1	01	01	H3447_038_2	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	038	2	1	01	01	H3447_038_2	7	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	038	2	1	01	01	H3447_038_2	7	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	039	0	1	01	01	H3447_039_0	7	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					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												
H3447	039	0	1	01	01	H3447_039_0	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	039	0	1	01	01	H3447_039_0	7	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	039	0	1	01	01	H3447_039_0	7	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	039	0	1	01	01	H3447_039_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	039	0	1	01	01	H3447_039_0	7	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	039	0	1	01	01	H3447_039_0	7	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	6	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	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	023	1	1	01	01	H3449_023_1	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H3449	023	1	1	01	01	H3449_023_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	01	01	H3449_023_1	6	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	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	6	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	6	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	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	023	2	1	01	01	H3449_023_2	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H3449	023	2	1	01	01	H3449_023_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	01	01	H3449_023_2	6	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	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	6	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	6	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	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	023	4	1	01	01	H3449_023_4	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H3449	023	4	1	01	01	H3449_023_4	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	01	01	H3449_023_4	6	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	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	6	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	6	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	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	023	5	1	01	01	H3449_023_5	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H3449	023	5	1	01	01	H3449_023_5	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	5	1	01	01	H3449_023_5	6	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	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	6	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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H3449	024	1	1	01	01	H3449_024_1	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	01	01	H3449_024_1	5	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H3449	024	2	1	01	01	H3449_024_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	01	01	H3449_024_2	5	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	5	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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H3449	024	3	1	01	01	H3449_024_3	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	3	1	01	01	H3449_024_3	5	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	5	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	026	0	1	01	01	H3449_026_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H3449	026	0	1	01	01	H3449_026_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	026	0	1	01	01	H3449_026_0	5	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	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	027	1	1	01	01	H3449_027_1	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				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	027	1	1	01	01	H3449_027_1	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				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	027	1	1	01	01	H3449_027_1	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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	027	1	1	01	01	H3449_027_1	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H3449	027	1	1	01	01	H3449_027_1	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	027	1	1	01	01	H3449_027_1	5	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	027	1	1	01	01	H3449_027_1	5	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	027	2	1	01	01	H3449_027_2	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				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	027	2	1	01	01	H3449_027_2	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				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	027	2	1	01	01	H3449_027_2	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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	027	2	1	01	01	H3449_027_2	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H3449	027	2	1	01	01	H3449_027_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	027	2	1	01	01	H3449_027_2	5	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	027	2	1	01	01	H3449_027_2	5	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	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												
H3464	001	0	1	01	01	H3464_001_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3464	001	0	1	01	01	H3464_001_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	001	0	1	01	01	H3464_001_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3464	001	0	1	01	01	H3464_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	001	0	1	01	01	H3464_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	001	0	1	01	01	H3464_001_0	3	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	002	0	1	01	01	H3464_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	002	0	1	01	01	H3464_002_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3464	002	0	1	01	01	H3464_002_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	002	0	1	01	01	H3464_002_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3464	002	0	1	01	01	H3464_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	002	0	1	01	01	H3464_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	002	0	1	01	01	H3464_002_0	3	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												
H3471	001	0	1	01	01	H3471_001_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3471	001	0	1	01	01	H3471_001_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				61.58	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3471	002	0	1	01	01	H3471_002_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	Preferred Brand	4	10	1	2	3	1	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	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				51.10	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3471	004	0	1	01	01	H3471_004_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				60.81	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3471	005	0	1	01	01	H3471_005_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				53.22	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3471	010	0	1	01	01	H3471_010_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				50.80	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3471	013	0	1	02	01	H3471_013_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				51.89	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3471	014	0	1	02	01	H3471_014_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				49.58	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	017	0	1	01	01	H3471_017_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3471	017	0	1	01	01	H3471_017_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				51.30	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	017	0	1	01	01	H3471_017_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					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	9	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	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3471	018	0	1	02	01	H3471_018_0	9	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				88.59	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	018	0	1	02	01	H3471_018_0	9	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												
H3471	019	0	1	01	01	H3471_019_0	10	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	019	0	1	01	01	H3471_019_0	10	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3471	019	0	1	01	01	H3471_019_0	10	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	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	019	0	1	01	01	H3471_019_0	10	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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	019	0	1	01	01	H3471_019_0	10	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				55.01	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	019	0	1	01	01	H3471_019_0	10	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												
H3499	002	0	1	01	01	H3499_002_0	3	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_002_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H3499	002	0	1	01	01	H3499_002_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H3499	002	0	1	01	01	H3499_002_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.96	45	45	45				95.52	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_002_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_002_0	3	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	005	0	1	01	01	H3499_005_0	3	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	11.00	22.00	33.00																									11.00	22.00	33.00				11.00	22.00	0.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	005	0	1	01	01	H3499_005_0	3	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	005	0	1	01	01	H3499_005_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.04	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	005	0	1	01	01	H3499_005_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, Select Care Drugs												
H3499	005	0	1	01	01	H3499_005_0	3	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	007	0	1	01	01	H3499_007_0	3	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	007	0	1	01	01	H3499_007_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H3499	007	0	1	01	01	H3499_007_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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												
H3499	007	0	1	01	01	H3499_007_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											91.53	50	50	50				87.86	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	007	0	1	01	01	H3499_007_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	007	0	1	01	01	H3499_007_0	3	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	008	0	1	01	01	H3499_008_0	3	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	008	0	1	01	01	H3499_008_0	3	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	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, Select Care Drugs												
H3499	008	0	1	01	01	H3499_008_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.25	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	008	0	1	01	01	H3499_008_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, Select Care Drugs												
H3499	008	0	1	01	01	H3499_008_0	3	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	006	0	1	02	01	H3528_006_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.07		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.07		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3528	006	0	1	02	01	H3528_006_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				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												
H3528	006	0	1	02	01	H3528_006_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				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										1		
H3528	006	0	1	02	01	H3528_006_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
H3528	006	0	1	02	01	H3528_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											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												
H3528	006	0	1	02	01	H3528_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.07		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	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												
H3528	010	0	1	01	01	H3528_010_0	3	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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												
H3528	010	0	1	01	01	H3528_010_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				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												
H3528	010	0	1	01	01	H3528_010_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	1	1	02	01	H3528_011_1	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.07		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	1	1	02	01	H3528_011_1	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				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												
H3528	011	1	1	02	01	H3528_011_1	3	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3528	011	1	1	02	01	H3528_011_1	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H3528	011	1	1	02	01	H3528_011_1	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	2	1	02	01	H3528_011_2	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.07		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	2	1	02	01	H3528_011_2	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				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												
H3528	011	2	1	02	01	H3528_011_2	3	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3528	011	2	1	02	01	H3528_011_2	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H3528	011	2	1	02	01	H3528_011_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	014	0	1	01	01	H3528_014_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	.07		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	014	0	1	01	01	H3528_014_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				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												
H3528	014	0	1	01	01	H3528_014_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3528	014	0	1	01	01	H3528_014_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H3528	014	0	1	01	01	H3528_014_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												
H3528	015	0	1	02	01	H3528_015_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.07		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	015	0	1	02	01	H3528_015_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	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												
H3528	015	0	1	02	01	H3528_015_0	3	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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												
H3528	015	0	1	02	01	H3528_015_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				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												
H3528	015	0	1	02	01	H3528_015_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	016	0	1	01	01	H3528_016_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.07		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	016	0	1	01	01	H3528_016_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.07		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3528	016	0	1	01	01	H3528_016_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				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												
H3528	016	0	1	01	01	H3528_016_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				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										1		
H3528	016	0	1	01	01	H3528_016_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
H3528	016	0	1	01	01	H3528_016_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H3528	016	0	1	01	01	H3528_016_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	017	0	1	01	01	H3528_017_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.07		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	017	0	1	01	01	H3528_017_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				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												
H3528	017	0	1	01	01	H3528_017_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H3528	017	0	1	01	01	H3528_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H3528	017	0	1	01	01	H3528_017_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												
H3533	001	0	1	01	01	H3533_001_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	002	0	1	01	01	H3533_002_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	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												
H3533	006	0	1	01	01	H3533_006_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	027	0	1	01	01	H3533_027_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	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												
H3533	032	1	1	01	01	H3533_032_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	1	1	01	01	H3533_032_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	2	1	01	01	H3533_032_2	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	2	1	01	01	H3533_032_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	033	0	1	01	01	H3533_033_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	033	0	1	01	01	H3533_033_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	033	0	1	01	01	H3533_033_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	033	0	1	01	01	H3533_033_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	034	1	1	01	01	H3533_034_1	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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												
H3533	034	1	1	01	01	H3533_034_1	4	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	034	1	1	01	01	H3533_034_1	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	034	1	1	01	01	H3533_034_1	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	034	1	1	01	01	H3533_034_1	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	034	2	1	01	01	H3533_034_2	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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												
H3533	034	2	1	01	01	H3533_034_2	4	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	034	2	1	01	01	H3533_034_2	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	034	2	1	01	01	H3533_034_2	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	034	2	1	01	01	H3533_034_2	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3536	002	0	1	01	01	H3536_002_0	6	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	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	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	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	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	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					0.00	0.00	0.00																4.00				4.00			0.13	0.13	0.00			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	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	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	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	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	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	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					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, Select Care Drugs												
H3536	005	0	1	01	01	H3536_005_0	6	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	005	0	1	01	01	H3536_005_0	6	Preferred Brand	4	11	1	2	3	1		111	01	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	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	005	0	1	01	01	H3536_005_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	005	0	1	01	01	H3536_005_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	006	0	1	01	01	H3536_006_0	7	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					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	006	0	1	01	01	H3536_006_0	7	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	006	0	1	01	01	H3536_006_0	7	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	006	0	1	01	01	H3536_006_0	7	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	188.00	188.00																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												
H3536	006	0	1	01	01	H3536_006_0	7	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												
H3536	006	0	1	01	01	H3536_006_0	7	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	006	0	1	01	01	H3536_006_0	7	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	002	0	1	04	01	H3554_002_0	4	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 Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	4	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	15.00		30.00																			15.00		0.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	4	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	002	0	1	04	01	H3554_002_0	4	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	002	0	1	04	01	H3554_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	4	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	4	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	4	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	4	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	4	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	003	0	1	04	01	H3554_003_0	4	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	003	0	1	04	01	H3554_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	003	0	1	04	01	H3554_003_0	4	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	4	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	4	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	004	0	1	04	01	H3554_004_0	4	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	4	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	4	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	004	0	1	04	01	H3554_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	004	0	1	04	01	H3554_004_0	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	007	0	1	04	01	H3554_007_0	4	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	4	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	4	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	4	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	008	0	1	04	01	H3554_008_0	4	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	4	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	4	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	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	008	0	1	04	01	H3554_008_0	4	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	4	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	8	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	8	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	8	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	8	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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	001	0	1	01	01	H3561_001_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	11.00	22.00	33.00																									11.00	22.00	33.00				11.00	22.00	0.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.70	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	5	Specialty Tier	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												
H3561	001	0	1	01	01	H3561_001_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				96.39	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3597	001	0	1	01	01	H3597_001_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1071.24	33						658.99	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	007	0	1	01	01	H3597_007_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3597	007	0	1	01	01	H3597_007_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	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					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												
H3597	007	0	1	01	01	H3597_007_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	007	0	1	01	01	H3597_007_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	007	0	1	01	01	H3597_007_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1052.55	33						473.36	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	009	0	1	01	01	H3597_009_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3597	009	0	1	01	01	H3597_009_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	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					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												
H3597	009	0	1	01	01	H3597_009_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	009	0	1	01	01	H3597_009_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	009	0	1	01	01	H3597_009_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											971.92	30						452.83	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	011	0	1	02	01	H3597_011_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3597	011	0	1	02	01	H3597_011_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3597	011	0	1	02	01	H3597_011_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	011	0	1	02	01	H3597_011_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											55.95	30	30	30				52.74	30	30	30										30	30	30				30	30	30				30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	011	0	1	02	01	H3597_011_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											638.51	25						415.16	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3632	001	0	1	04	01	H3632_001_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											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												
H3632	001	0	1	04	01	H3632_001_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				10.00			0.67	0.33		0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3632	001	0	1	04	01	H3632_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00			1.57	1.57		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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											52.60	50	50	50				53.29	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3632	001	0	1	04	01	H3632_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	6	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	6	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	6	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				834.37	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	6	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	6	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	6	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1580.94	32																																					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	6	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	6	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	6	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1398.43	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	023	0	1	01	01	H3653_023_0	6	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	023	0	1	01	01	H3653_023_0	6	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	023	0	1	01	01	H3653_023_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	023	0	1	01	01	H3653_023_0	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	023	0	1	01	01	H3653_023_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			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	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1477.50	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	6	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	6	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	024	0	1	01	01	H3653_024_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1476.24	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3655	033	0	1	01	01	H3655_033_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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												
H3655	033	0	1	01	01	H3655_033_0	7	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												
H3655	033	0	1	01	01	H3655_033_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	7	Select Care Drugs	4	01	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	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												
H3655	034	0	1	01	01	H3655_034_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					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	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	7	Preferred Brand	4	11	1	2	3	1		111	01	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	7	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	7	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					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	7	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	038	0	1	01	01	H3655_038_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	038	0	1	01	01	H3655_038_0	7	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	7	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	041	0	1	01	01	H3655_041_0	7	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					0.00	0.00	0.00																7.00				7.00			0.23	0.23	0.00			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	7	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	7	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	042	0	1	01	01	H3655_042_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	042	0	1	01	01	H3655_042_0	7	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	7	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	044	0	1	01	01	H3655_044_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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												
H3655	044	0	1	01	01	H3655_044_0	7	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												
H3655	044	0	1	01	01	H3655_044_0	7	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	044	0	1	01	01	H3655_044_0	7	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	044	0	1	01	01	H3655_044_0	7	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												
H3655	044	0	1	01	01	H3655_044_0	7	Select Care Drugs	4	01	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	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												
H3655	045	1	1	01	01	H3655_045_1	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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	045	1	1	01	01	H3655_045_1	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	045	1	1	01	01	H3655_045_1	7	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	045	1	1	01	01	H3655_045_1	7	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	045	1	1	01	01	H3655_045_1	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	045	1	1	01	01	H3655_045_1	7	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	045	1	1	01	01	H3655_045_1	7	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	045	2	1	01	01	H3655_045_2	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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	045	2	1	01	01	H3655_045_2	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	045	2	1	01	01	H3655_045_2	7	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	045	2	1	01	01	H3655_045_2	7	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	045	2	1	01	01	H3655_045_2	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	045	2	1	01	01	H3655_045_2	7	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	045	2	1	01	01	H3655_045_2	7	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	045	3	1	01	01	H3655_045_3	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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	045	3	1	01	01	H3655_045_3	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	045	3	1	01	01	H3655_045_3	7	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	045	3	1	01	01	H3655_045_3	7	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	045	3	1	01	01	H3655_045_3	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	045	3	1	01	01	H3655_045_3	7	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	045	3	1	01	01	H3655_045_3	7	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	045	4	1	01	01	H3655_045_4	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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	045	4	1	01	01	H3655_045_4	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	045	4	1	01	01	H3655_045_4	7	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	045	4	1	01	01	H3655_045_4	7	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	045	4	1	01	01	H3655_045_4	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	045	4	1	01	01	H3655_045_4	7	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	045	4	1	01	01	H3655_045_4	7	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	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		100				1	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, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		100				1	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, Vaccines										1		
H3660	028	0	1	02	01	H3660_028_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	5	Preferred Brand	4	11	3	2	3	1	110		01	100		1	30		90				1	2			90				30		31	39.00		97.50																					97.50																39.00				39.00		1.30						1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	5	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	5	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H3660	029	0	1	02	01	H3660_029_0	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		100				1	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, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		100				1	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, Vaccines										1		
H3660	029	0	1	02	01	H3660_029_0	7	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	7	Preferred Brand	4	11	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 Drug, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	7	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 Drug, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	7	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 Drug, Specialty Tier, Vaccines										1		
H3660	044	0	1	01	01	H3660_044_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		100				1	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, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	8	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		100				1	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, Vaccines										1		
H3660	044	0	1	01	01	H3660_044_0	8	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	8	Preferred Brand	4	11	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 Drug, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	8	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	8	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H3660	050	0	1	01	01	H3660_050_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		100				1	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, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		100				1	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, Vaccines										1		
H3660	050	0	1	01	01	H3660_050_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	5	Preferred Brand	4	11	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 Drug, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	5	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	5	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H3660	053	1	1	01	01	H3660_053_1	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		100				1	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, Vaccines												
H3660	053	1	1	01	01	H3660_053_1	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		100				1	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, Vaccines										1		
H3660	053	1	1	01	01	H3660_053_1	5	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	053	1	1	01	01	H3660_053_1	5	Preferred Brand	4	11	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 Drug, Specialty Tier, Vaccines												
H3660	053	1	1	01	01	H3660_053_1	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	053	1	1	01	01	H3660_053_1	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	053	1	1	01	01	H3660_053_1	5	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	053	1	1	01	01	H3660_053_1	5	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H3660	053	2	1	01	01	H3660_053_2	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		100				1	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, Vaccines												
H3660	053	2	1	01	01	H3660_053_2	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		100				1	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, Vaccines										1		
H3660	053	2	1	01	01	H3660_053_2	5	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	053	2	1	01	01	H3660_053_2	5	Preferred Brand	4	11	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 Drug, Specialty Tier, Vaccines												
H3660	053	2	1	01	01	H3660_053_2	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	053	2	1	01	01	H3660_053_2	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	053	2	1	01	01	H3660_053_2	5	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3660	053	2	1	01	01	H3660_053_2	5	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H3664	017	0	1	02	01	H3664_017_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					8.00	16.00	24.00					8.00	16.00	20.00																16.00				8.00			0.53	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					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	Non-Preferred Drug	4	11	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											827.68	31						827.68	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	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	Preferred Brand	4	11	1	2	3	1		111	01	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	Non-Preferred Drug	4	11	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											856.90	30						856.90	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	Generic	4	01	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	Preferred Brand	4	11	1	2	3	1		111	01	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	Non-Preferred Drug	4	11	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											957.13	29						957.13	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	014	0	1	01	01	H3668_014_0	5	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	45.00																			0.00	0.00	0.00																15.00				15.00		0.50			0.00			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	015	0	1	01	01	H3668_015_0	5	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	016	0	1	01	01	H3668_016_0	5	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			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	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	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	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	018	1	1	01	01	H3668_018_1	5	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	018	2	1	01	01	H3668_018_2	5	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	3	1	01	01	H3668_018_3	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	3	1	01	01	H3668_018_3	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	018	3	1	01	01	H3668_018_3	5	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	3	1	01	01	H3668_018_3	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	3	1	01	01	H3668_018_3	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	1	1	01	01	H3668_019_1	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			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	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	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	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	1	1	01	01	H3668_019_1	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	1	1	01	01	H3668_019_1	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	2	1	01	01	H3668_019_2	5	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	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	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	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	2	1	01	01	H3668_019_2	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	2	1	01	01	H3668_019_2	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	3	1	01	01	H3668_019_3	5	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	020	0	1	01	01	H3668_020_0	5	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	021	0	1	01	01	H3668_021_0	5	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	022	0	1	01	01	H3668_022_0	5	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	023	0	1	01	01	H3668_023_0	5	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	024	0	1	01	01	H3668_024_0	5	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	025	0	1	01	01	H3668_025_0	5	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	026	0	1	01	01	H3668_026_0	5	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					3.00	6.00	9.00											13.00	26.00	39.00				3.00	0.00	0.00				13.00				13.00			0.43	0.10		0.43	0.10	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	0.00	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												
H3672	013	0	1	01	01	H3672_013_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	6	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			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					3.00	6.00	9.00											13.00	26.00	39.00				3.00	0.00	0.00				13.00				13.00			0.43	0.10		0.43	0.10	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	0.00	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												
H3672	020	0	1	01	01	H3672_020_0	8	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
H3672	020	0	1	01	01	H3672_020_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	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												
H3672	020	0	1	01	01	H3672_020_0	8	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			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					3.00	6.00	9.00											13.00	26.00	39.00				3.00	0.00	0.00				13.00				13.00			0.43	0.10		0.43	0.10	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	0.00	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												
H3672	023	0	1	01	01	H3672_023_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
H3672	023	0	1	01	01	H3672_023_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	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												
H3672	023	0	1	01	01	H3672_023_0	6	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			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	9	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	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	9	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	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	9	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	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	9	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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	9	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		100	1	1				30		100	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	9	Specialty Tier	4	11	1	1	5	1		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	9	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	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	9	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	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	9	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	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	9	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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	9	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		100	1	1				30		100	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	9	Specialty Tier	4	11	1	1	5	1		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	9	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	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	9	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	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	9	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	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	9	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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	9	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		100	1	1				30		100	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	9	Specialty Tier	4	11	1	1	5	1		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	022	0	1	01	01	H3706_022_0	9	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	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	022	0	1	01	01	H3706_022_0	9	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	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	022	0	1	01	01	H3706_022_0	9	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	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	022	0	1	01	01	H3706_022_0	9	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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	022	0	1	01	01	H3706_022_0	9	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	022	0	1	01	01	H3706_022_0	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		100	1	1				30		100	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	022	0	1	01	01	H3706_022_0	9	Specialty Tier	4	11	1	1	5	1		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	023	0	1	01	01	H3706_023_0	9	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	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	023	0	1	01	01	H3706_023_0	9	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	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	023	0	1	01	01	H3706_023_0	9	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	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	023	0	1	01	01	H3706_023_0	9	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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	023	0	1	01	01	H3706_023_0	9	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	023	0	1	01	01	H3706_023_0	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		100	1	1				30		100	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	023	0	1	01	01	H3706_023_0	9	Specialty Tier	4	11	1	1	5	1		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	024	0	1	01	01	H3706_024_0	8	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	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												
H3706	024	0	1	01	01	H3706_024_0	8	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	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										1		
H3706	024	0	1	01	01	H3706_024_0	8	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	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	024	0	1	01	01	H3706_024_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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	024	0	1	01	01	H3706_024_0	8	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	024	0	1	01	01	H3706_024_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		100	1	1				30		100	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		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												
H3706	024	0	1	01	01	H3706_024_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	025	0	1	01	01	H3706_025_0	9	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	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												
H3706	025	0	1	01	01	H3706_025_0	9	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	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										1		
H3706	025	0	1	01	01	H3706_025_0	9	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	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	025	0	1	01	01	H3706_025_0	9	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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	025	0	1	01	01	H3706_025_0	9	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	025	0	1	01	01	H3706_025_0	9	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		100	1	1				30		100	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		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												
H3706	025	0	1	01	01	H3706_025_0	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	1	1	01	01	H3727_001_1	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	17.00	34.00	51.00																			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	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			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	7	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	7	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				175.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	2	1	01	01	H3727_001_2	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	17.00	34.00	51.00																			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	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			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	7	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	7	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				175.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	3	1	01	01	H3727_001_3	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			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	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	17.00	34.00	51.00																			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	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			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	6	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	6	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				175.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	001	0	1	02	01	H3748_001_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	001	0	1	02	01	H3748_001_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3748_001_0	2	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					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												
H3748	001	0	1	02	01	H3748_001_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3748_001_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	001	0	1	02	01	H3748_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	001	0	1	02	01	H3748_001_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1101.70	33						506.10	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	003	0	1	02	01	H3748_003_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	003	0	1	02	01	H3748_003_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3748_003_0	2	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					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												
H3748	003	0	1	02	01	H3748_003_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3748_003_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	003	0	1	02	01	H3748_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	003	0	1	02	01	H3748_003_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1000.47	33						559.32	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	004	0	1	02	01	H3748_004_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	004	0	1	02	01	H3748_004_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3748_004_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	004	0	1	02	01	H3748_004_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3748_004_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	004	0	1	02	01	H3748_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	004	0	1	02	01	H3748_004_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1079.87	33						619.42	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	005	0	1	02	01	H3748_005_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	005	0	1	02	01	H3748_005_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3748_005_0	2	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					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												
H3748	005	0	1	02	01	H3748_005_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3748_005_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	005	0	1	02	01	H3748_005_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	005	0	1	02	01	H3748_005_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1030.72	33						377.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	006	0	1	02	01	H3748_006_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	006	0	1	02	01	H3748_006_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3748_006_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	006	0	1	02	01	H3748_006_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3748_006_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	006	0	1	02	01	H3748_006_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	006	0	1	02	01	H3748_006_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1030.76	33						377.54	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	007	0	1	02	01	H3748_007_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	007	0	1	02	01	H3748_007_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3748_007_0	2	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					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												
H3748	007	0	1	02	01	H3748_007_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3748_007_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	007	0	1	02	01	H3748_007_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	007	0	1	02	01	H3748_007_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1030.72	33						377.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	008	0	1	02	01	H3748_008_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	008	0	1	02	01	H3748_008_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3748_008_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	008	0	1	02	01	H3748_008_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	008	0	1	02	01	H3748_008_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	008	0	1	02	01	H3748_008_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	008	0	1	02	01	H3748_008_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1030.76	33						377.54	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	009	0	1	02	01	H3748_009_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	009	0	1	02	01	H3748_009_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3748_009_0	3	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					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												
H3748	009	0	1	02	01	H3748_009_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3748_009_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	009	0	1	02	01	H3748_009_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	009	0	1	02	01	H3748_009_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1030.72	33						377.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	001	0	1	02	01	H3749_001_0	5	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												
H3749	001	0	1	02	01	H3749_001_0	5	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		
H3749	001	0	1	02	01	H3749_001_0	5	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												
H3749	001	0	1	02	01	H3749_001_0	5	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
H3749	001	0	1	02	01	H3749_001_0	5	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												
H3749	001	0	1	02	01	H3749_001_0	5	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												
H3749	001	0	1	02	01	H3749_001_0	5	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												
H3749	017	0	1	02	01	H3749_017_0	5	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												
H3749	017	0	1	02	01	H3749_017_0	5	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		
H3749	017	0	1	02	01	H3749_017_0	5	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												
H3749	017	0	1	02	01	H3749_017_0	5	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
H3749	017	0	1	02	01	H3749_017_0	5	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												
H3749	017	0	1	02	01	H3749_017_0	5	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												
H3749	017	0	1	02	01	H3749_017_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				340.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	02	01	H3749_018_0	5	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												
H3749	018	0	1	02	01	H3749_018_0	5	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		
H3749	018	0	1	02	01	H3749_018_0	5	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												
H3749	018	0	1	02	01	H3749_018_0	5	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
H3749	018	0	1	02	01	H3749_018_0	5	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												
H3749	018	0	1	02	01	H3749_018_0	5	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												
H3749	018	0	1	02	01	H3749_018_0	5	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												
H3749	020	0	1	02	01	H3749_020_0	5	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												
H3749	020	0	1	02	01	H3749_020_0	5	Preferred Generic	4	01	1	2	1	3	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										1		
H3749	020	0	1	02	01	H3749_020_0	5	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												
H3749	020	0	1	02	01	H3749_020_0	5	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
H3749	020	0	1	02	01	H3749_020_0	5	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												
H3749	020	0	1	02	01	H3749_020_0	5	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												
H3749	020	0	1	02	01	H3749_020_0	5	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												
H3755	001	0	1	01	01	H3755_001_0	8	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	8	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	8	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	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	001	0	1	01	01	H3755_001_0	8	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	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	001	0	1	01	01	H3755_001_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	8	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1393.00	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	7	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	7	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	7	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	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	004	0	1	01	01	H3755_004_0	7	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	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	004	0	1	01	01	H3755_004_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1394.00	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	7	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	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	7	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	7	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	10.00	10.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	7	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																			10.00	10.00	10.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3755	005	0	1	01	01	H3755_005_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1293.00	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	10	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	2	1	01	01	H3777_001_2	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				918.72	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	2	1	01	01	H3777_001_2	10	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	2	1	01	01	H3777_001_2	10	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	10	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	3	1	01	01	H3777_001_3	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				918.72	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	3	1	01	01	H3777_001_3	10	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	3	1	01	01	H3777_001_3	10	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	10	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	4	1	01	01	H3777_001_4	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				918.72	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	4	1	01	01	H3777_001_4	10	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	4	1	01	01	H3777_001_4	10	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	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												
H3805	001	0	1	01	01	H3805_001_0	3	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		
H3805	001	0	1	01	01	H3805_001_0	3	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												
H3805	001	0	1	01	01	H3805_001_0	3	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
H3805	001	0	1	01	01	H3805_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				395.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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												
H3805	007	0	1	01	01	H3805_007_0	3	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		
H3805	007	0	1	01	01	H3805_007_0	3	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												
H3805	007	0	1	01	01	H3805_007_0	3	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
H3805	007	0	1	01	01	H3805_007_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				138.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	4	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												
H3805	015	0	1	01	01	H3805_015_0	4	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		
H3805	015	0	1	01	01	H3805_015_0	4	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												
H3805	015	0	1	01	01	H3805_015_0	4	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
H3805	015	0	1	01	01	H3805_015_0	4	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												
H3805	015	0	1	01	01	H3805_015_0	4	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												
H3805	015	0	1	01	01	H3805_015_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				208.00	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	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												
H3805	017	0	1	01	01	H3805_017_0	3	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		
H3805	017	0	1	01	01	H3805_017_0	3	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												
H3805	017	0	1	01	01	H3805_017_0	3	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
H3805	017	0	1	01	01	H3805_017_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				254.00	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	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												
H3805	019	0	1	01	01	H3805_019_0	3	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		
H3805	019	0	1	01	01	H3805_019_0	3	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												
H3805	019	0	1	01	01	H3805_019_0	3	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
H3805	019	0	1	01	01	H3805_019_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	3	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												
H3805	023	1	1	01	01	H3805_023_1	3	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												
H3805	023	1	1	01	01	H3805_023_1	3	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		
H3805	023	1	1	01	01	H3805_023_1	3	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												
H3805	023	1	1	01	01	H3805_023_1	3	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
H3805	023	1	1	01	01	H3805_023_1	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	1	1	01	01	H3805_023_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	1	1	01	01	H3805_023_1	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				209.00	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	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												
H3805	023	2	1	01	01	H3805_023_2	3	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		
H3805	023	2	1	01	01	H3805_023_2	3	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												
H3805	023	2	1	01	01	H3805_023_2	3	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
H3805	023	2	1	01	01	H3805_023_2	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	2	1	01	01	H3805_023_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	2	1	01	01	H3805_023_2	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				209.00	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	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												
H3805	025	1	1	01	01	H3805_025_1	3	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		
H3805	025	1	1	01	01	H3805_025_1	3	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												
H3805	025	1	1	01	01	H3805_025_1	3	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
H3805	025	1	1	01	01	H3805_025_1	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	1	1	01	01	H3805_025_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	1	1	01	01	H3805_025_1	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				279.00	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	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												
H3805	025	2	1	01	01	H3805_025_2	3	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		
H3805	025	2	1	01	01	H3805_025_2	3	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												
H3805	025	2	1	01	01	H3805_025_2	3	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
H3805	025	2	1	01	01	H3805_025_2	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	2	1	01	01	H3805_025_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	2	1	01	01	H3805_025_2	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				279.00	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	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												
H3805	029	0	1	01	01	H3805_029_0	3	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		
H3805	029	0	1	01	01	H3805_029_0	3	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												
H3805	029	0	1	01	01	H3805_029_0	3	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
H3805	029	0	1	01	01	H3805_029_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	029	0	1	01	01	H3805_029_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	029	0	1	01	01	H3805_029_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				520.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	030	0	1	01	01	H3805_030_0	3	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												
H3805	030	0	1	01	01	H3805_030_0	3	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		
H3805	030	0	1	01	01	H3805_030_0	3	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												
H3805	030	0	1	01	01	H3805_030_0	3	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
H3805	030	0	1	01	01	H3805_030_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					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	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												
H3805	030	0	1	01	01	H3805_030_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											356.00	31						312.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	032	0	1	02	01	H3805_032_0	5	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												
H3805	032	0	1	02	01	H3805_032_0	5	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		
H3805	032	0	1	02	01	H3805_032_0	5	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												
H3805	032	0	1	02	01	H3805_032_0	5	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
H3805	032	0	1	02	01	H3805_032_0	5	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												
H3805	032	0	1	02	01	H3805_032_0	5	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												
H3805	032	0	1	02	01	H3805_032_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											597.00	33						278.00	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	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												
H3805	033	0	1	02	01	H3805_033_0	3	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		
H3805	033	0	1	02	01	H3805_033_0	3	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												
H3805	033	0	1	02	01	H3805_033_0	3	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
H3805	033	0	1	02	01	H3805_033_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	033	0	1	02	01	H3805_033_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	033	0	1	02	01	H3805_033_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				438.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	034	0	1	02	01	H3805_034_0	3	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												
H3805	034	0	1	02	01	H3805_034_0	3	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		
H3805	034	0	1	02	01	H3805_034_0	3	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												
H3805	034	0	1	02	01	H3805_034_0	3	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
H3805	034	0	1	02	01	H3805_034_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	034	0	1	02	01	H3805_034_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	034	0	1	02	01	H3805_034_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				442.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	036	0	1	01	01	H3805_036_0	3	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												
H3805	036	0	1	01	01	H3805_036_0	3	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		
H3805	036	0	1	01	01	H3805_036_0	3	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												
H3805	036	0	1	01	01	H3805_036_0	3	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
H3805	036	0	1	01	01	H3805_036_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	036	0	1	01	01	H3805_036_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	036	0	1	01	01	H3805_036_0	3	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												
H3805	037	0	1	01	01	H3805_037_0	3	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												
H3805	037	0	1	01	01	H3805_037_0	3	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		
H3805	037	0	1	01	01	H3805_037_0	3	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												
H3805	037	0	1	01	01	H3805_037_0	3	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
H3805	037	0	1	01	01	H3805_037_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	037	0	1	01	01	H3805_037_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	037	0	1	01	01	H3805_037_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				311.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	6	Preferred Generic	4	01	3	2	1	1	111		01		100	1	30	60	100				1	2						100	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	6	Preferred Generic	4	01	3	2	1	3	111		01		100	1	30	60	100				1	2						100	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	6	Generic	4	01	1	2	2	1	111		01		100	1	30	60	100				1	2						100	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	6	Preferred Brand	4	10	1	2	3	1	111		01		100	1	30	60	100				1	2						100	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	6	Non-Preferred Brand	4	10	1	2	4	1	111		01		100	1	30	60	100				1	2						100	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	6	Specialty Tier	4	11	1	1	5	1	111		01		100	1	30	60	100				1	2						100	30		31				0.00	30	30	30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	6	Select Care Drugs	4	11	1	2	6	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	6	Select Care Drugs	4	11	1	2	6	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						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	6	Preferred Generic	4	01	3	2	1	1	111		01		100	1	30	60	100				1	2						100	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	6	Preferred Generic	4	01	3	2	1	3	111		01		100	1	30	60	100				1	2						100	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	6	Generic	4	01	1	2	2	1	111		01		100	1	30	60	100				1	2						100	30		31	15.00	30.00	45.00																											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	6	Preferred Brand	4	10	1	2	3	1	111		01		100	1	30	60	100				1	2						100	30		31	47.00	94.00	141.00																											141.00						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	6	Non-Preferred Brand	4	10	1	2	4	1	111		01		100	1	30	60	100				1	2						100	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	6	Specialty Tier	4	11	1	1	5	1	111		01		100	1	30	60	100				1	2						100	30		31				0.00	28	28	28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	022	0	1	01	01	H3810_022_0	6	Select Care Drugs	4	11	1	2	6	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	022	0	1	01	01	H3810_022_0	6	Select Care Drugs	4	11	1	2	6	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						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	6	Preferred Generic	4	11	1	2	1	1	111		01	100		1	34	60	90				1	2			90				34		31	3.00	6.00	6.00																					6.00																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	6	Generic	4	11	1	2	2	1	111		01	100		1	34	60	90				1	2			90				34		31	9.00	18.00	18.00																					18.00																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	6	Preferred Brand	4	11	1	2	3	1	111		01	100		1	34	60	90				1	2			90				34		31	47.00	94.00	94.00																					94.00																47.00				47.00		1.38						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	002	0	1	01	01	H3811_002_0	6	Non-Preferred Drug	4	11	1	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	6	Specialty Tier	4	11	1	1	5	1	010		01			1	34														34		31				1102.77	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	6	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	34	60	90				1	2			90				34		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	6	Preferred Generic	4	11	1	2	1	1	111		01	100		1	34	60	90				1	2			90				34		31	3.00	6.00	6.00																					6.00																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	6	Preferred Generic	4	11	1	2	1	3	111		01	100		1	34	60	90				1	2			90				34		31	3.00	6.00	6.00																					6.00																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	6	Generic	4	11	1	2	2	1	111		01	100		1	34	60	90				1	2			90				34		31	9.00	18.00	18.00																					18.00																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	6	Generic	4	11	1	2	2	3	111		01	100		1	34	60	90				1	2			90				34		31	9.00	18.00	18.00																					18.00																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	6	Preferred Brand	4	11	1	2	3	1	111		01	100		1	34	60	90				1	2			90				34		31	47.00	94.00	94.00																					94.00																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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01			1	34														34		31				1247.68	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	6	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	34	60	90				1	2			90				34		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	6	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	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	009	0	1	04	01	H3813_009_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	009	0	1	04	01	H3813_009_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	009	0	1	04	01	H3813_009_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	009	0	1	04	01	H3813_009_0	7	Preferred Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				230.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	009	0	1	04	01	H3813_009_0	7	Specialty Tier	4	11	1	1	6	1	010		01	010		1	30								30						30		31				250.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	009	0	1	04	01	H3813_009_0	7	Vaccines	4	10	1	2	7	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	010	0	1	04	01	H3813_010_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	010	0	1	04	01	H3813_010_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	010	0	1	04	01	H3813_010_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	010	0	1	04	01	H3813_010_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	010	0	1	04	01	H3813_010_0	7	Preferred Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				230.00	24																				24																	24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	010	0	1	04	01	H3813_010_0	7	Specialty Tier	4	11	1	1	6	1	010		01	010		1	30								30						30		31				250.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	010	0	1	04	01	H3813_010_0	7	Vaccines	4	10	1	2	7	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	011	0	1	04	01	H3813_011_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	011	0	1	04	01	H3813_011_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	011	0	1	04	01	H3813_011_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	011	0	1	04	01	H3813_011_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	011	0	1	04	01	H3813_011_0	7	Preferred Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				230.00	23																				23																	23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	011	0	1	04	01	H3813_011_0	7	Specialty Tier	4	11	1	1	6	1	010		01	010		1	30								30						30		31				250.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	011	0	1	04	01	H3813_011_0	7	Vaccines	4	10	1	2	7	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	012	0	1	04	01	H3813_012_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	012	0	1	04	01	H3813_012_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	012	0	1	04	01	H3813_012_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	012	0	1	04	01	H3813_012_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	012	0	1	04	01	H3813_012_0	7	Preferred Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				230.00	23																				23																	23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	012	0	1	04	01	H3813_012_0	7	Specialty Tier	4	11	1	1	6	1	010		01	010		1	30								30						30		31				250.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	012	0	1	04	01	H3813_012_0	7	Vaccines	4	10	1	2	7	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	013	0	1	04	01	H3813_013_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	013	0	1	04	01	H3813_013_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	013	0	1	04	01	H3813_013_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	013	0	1	04	01	H3813_013_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	013	0	1	04	01	H3813_013_0	7	Preferred Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				230.00	23																				23																	23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	013	0	1	04	01	H3813_013_0	7	Specialty Tier	4	11	1	1	6	1	010		01	010		1	30								30						30		31				250.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	013	0	1	04	01	H3813_013_0	7	Vaccines	4	10	1	2	7	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_0	8	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_0	8	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_0	8	Preferred Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				230.00	23																				23																	23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_0	8	Specialty Tier	4	11	1	1	6	1	010		01	010		1	30								30						30		31				250.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_0	8	Vaccines	4	10	1	2	7	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, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3815	001	0	1	01	01	H3815_001_0	4	Preferred Generic	4	11	1	2	1	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	4	Preferred Generic	4	11	1	2	1	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		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	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	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												
H3815	001	0	1	01	01	H3815_001_0	4	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	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, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	4	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			100.00		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	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				927.00	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	4	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		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	4	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		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	3	Preferred Generic	4	11	1	2	1	1	111		10	111		1	30	60	100				1	2	30	60	100					10	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												
H3815	006	0	1	01	01	H3815_006_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	10.00	20.00	30.00																			10.00	20.00	25.00																	10.00			10.00		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	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	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, Select Care Drugs												
H3815	006	0	1	01	01	H3815_006_0	3	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	232.50																	93.00			93.00		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	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				980.00	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	3	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	9.00																			3.00	6.00	9.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	3	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			100.00		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	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				830.00	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	3	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	3	Preferred Generic	4	11	1	2	1	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	008	0	1	01	01	H3815_008_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	1.00	2.00	3.00																			1.00	2.00	3.00																	1.00			1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	3	Generic	4	01	1	2	2	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	1.00	2.00	3.00																			1.00	2.00	3.00																	1.00			1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	008	0	1	01	01	H3815_008_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	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, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	3	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	75.00	150.00	225.00																			75.00	150.00	187.50																	75.00			75.00		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	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				935.00	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	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			5.00		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	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			5.00		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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	009	0	1	01	01	H3815_009_0	4	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																			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												
H3815	009	0	1	01	01	H3815_009_0	4	Preferred Brand	4	11	3	1	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31				89.00	25	25	25																		25	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	4	Non-Preferred Drug	4	11	3	1	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31				88.00	25	25	25																		25	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	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				678.00	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	4	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	3	Preferred Generic	4	11	1	2	1	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	010	0	1	01	01	H3815_010_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	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												
H3815	010	0	1	01	01	H3815_010_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	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, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	3	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	75.00	150.00	225.00																			75.00	150.00	187.50																	75.00			75.00		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	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				919.00	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	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			5.00		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	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			5.00		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	3	Preferred Generic	4	11	1	2	1	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	9.00																			3.00	6.00	9.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	10.00	20.00	30.00																			10.00	20.00	25.00																	10.00			10.00		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	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	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, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	3	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	232.50																	93.00			93.00		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	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				974.00	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	3	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	5	Preferred Generic	4	11	1	2	1	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	013	0	1	01	01	H3815_013_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	5	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	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, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	5	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			100.00		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	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1066.00	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	5	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	5	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	015	0	1	01	01	H3815_015_0	3	Preferred Generic	4	11	1	2	1	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	015	0	1	01	01	H3815_015_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	15.00																			5.00	10.00	15.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	015	0	1	01	01	H3815_015_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	30.00	60.00	90.00																			30.00	60.00	90.00																	30.00			30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	015	0	1	01	01	H3815_015_0	3	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			100.00		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	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				875.00	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	3	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			3.00		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	3	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			3.00		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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	016	0	1	01	01	H3815_016_0	4	Preferred Generic	4	11	1	2	1	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		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	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	9.00																			3.00	6.00	9.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	016	0	1	01	01	H3815_016_0	4	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	30.00	60.00	90.00																			30.00	60.00	90.00																	30.00			30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	016	0	1	01	01	H3815_016_0	4	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	75.00	150.00	225.00																			75.00	150.00	225.00																	75.00			75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	016	0	1	01	01	H3815_016_0	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1202.00	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	4	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	4	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	018	0	1	01	01	H3815_018_0	3	Preferred Generic	4	11	1	2	1	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	018	0	1	01	01	H3815_018_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	9.00																			3.00	6.00	9.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	018	0	1	01	01	H3815_018_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	30.00	60.00	90.00																			30.00	60.00	90.00																	30.00			30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	018	0	1	01	01	H3815_018_0	3	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	75.00	150.00	225.00																			75.00	150.00	225.00																	75.00			75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	018	0	1	01	01	H3815_018_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1018.00	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	3	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	019	0	1	01	01	H3815_019_0	4	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	15.00																			5.00	10.00	15.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	019	0	1	01	01	H3815_019_0	4	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	019	0	1	01	01	H3815_019_0	4	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			100.00		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	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				931.00	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	4	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	4	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	020	0	1	01	01	H3815_020_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	15.00																			5.00	10.00	15.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	020	0	1	01	01	H3815_020_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	020	0	1	01	01	H3815_020_0	3	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			100.00		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	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1084.00	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	3	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	021	0	1	01	01	H3815_021_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	15.00																			5.00	10.00	15.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	021	0	1	01	01	H3815_021_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	021	0	1	01	01	H3815_021_0	3	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			100.00		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	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1061.00	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	3	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	023	0	1	01	01	H3815_023_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	15.00																			5.00	10.00	15.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	023	0	1	01	01	H3815_023_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	023	0	1	01	01	H3815_023_0	3	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			100.00		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	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1024.00	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	3	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	025	0	1	01	01	H3815_025_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	10.00	20.00	30.00																			10.00	20.00	25.00																	10.00			10.00		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	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	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, Select Care Drugs												
H3815	025	0	1	01	01	H3815_025_0	3	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	232.50																	93.00			93.00		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	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				997.00	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	3	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	026	0	1	01	01	H3815_026_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	9.00																			3.00	6.00	9.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	026	0	1	01	01	H3815_026_0	5	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	026	0	1	01	01	H3815_026_0	5	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	279.00																	93.00			93.00		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	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1015.00	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	5	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		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	5	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	027	0	1	01	01	H3815_027_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	9.00																			3.00	6.00	9.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	027	0	1	01	01	H3815_027_0	5	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	027	0	1	01	01	H3815_027_0	5	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	279.00																	93.00			93.00		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	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1000.00	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	5	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		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	5	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	028	0	1	01	01	H3815_028_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	9.00																			3.00	6.00	9.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	028	0	1	01	01	H3815_028_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	028	0	1	01	01	H3815_028_0	3	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	279.00																	93.00			93.00		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	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1047.00	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	3	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			3.00		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	3	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			3.00		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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	029	0	1	01	01	H3815_029_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	9.00																			3.00	6.00	9.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	029	0	1	01	01	H3815_029_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	029	0	1	01	01	H3815_029_0	3	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	279.00																	93.00			93.00		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	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1008.00	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	3	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			3.00		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	3	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			3.00		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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	030	0	1	01	01	H3815_030_0	4	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																			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												
H3815	030	0	1	01	01	H3815_030_0	4	Preferred Brand	4	11	3	1	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31				88.00	25	25	25																		25	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	4	Non-Preferred Drug	4	11	3	1	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31				84.00	25	25	25																		25	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	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				669.00	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	4	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	031	0	1	01	01	H3815_031_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	9.00																			3.00	6.00	9.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	031	0	1	01	01	H3815_031_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	031	0	1	01	01	H3815_031_0	3	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	279.00																	93.00			93.00		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	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				999.00	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	3	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			3.00		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	3	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			3.00		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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	032	0	1	01	01	H3815_032_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	9.00																			3.00	6.00	9.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	032	0	1	01	01	H3815_032_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	032	0	1	01	01	H3815_032_0	3	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	279.00																	93.00			93.00		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	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1046.00	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	3	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			3.00		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	3	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			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	033	0	1	01	01	H3815_033_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	033	0	1	01	01	H3815_033_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	033	0	1	01	01	H3815_033_0	5	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	033	0	1	01	01	H3815_033_0	5	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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	033	0	1	01	01	H3815_033_0	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				872.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	033	0	1	01	01	H3815_033_0	5	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	033	0	1	01	01	H3815_033_0	5	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	034	0	1	01	01	H3815_034_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	034	0	1	01	01	H3815_034_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	1.00	2.00	3.00																			1.00	2.00	3.00																	1.00			1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	034	0	1	01	01	H3815_034_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	034	0	1	01	01	H3815_034_0	3	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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	034	0	1	01	01	H3815_034_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				934.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	034	0	1	01	01	H3815_034_0	3	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	034	0	1	01	01	H3815_034_0	3	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3817	008	1	1	04	01	H3817_008_1	7	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					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												
H3817	008	1	1	04	01	H3817_008_1	7	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	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1083.71	30						1083.71	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	7	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					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												
H3817	008	2	1	04	01	H3817_008_2	7	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	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1083.71	30						1083.71	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	1	1	04	01	H3817_009_1	7	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					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												
H3817	009	1	1	04	01	H3817_009_1	7	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					8.00	16.00	16.00					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												
H3817	009	1	1	04	01	H3817_009_1	7	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1192.09	33						1192.09	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	2	1	04	01	H3817_009_2	7	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					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												
H3817	009	2	1	04	01	H3817_009_2	7	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					8.00	16.00	16.00					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												
H3817	009	2	1	04	01	H3817_009_2	7	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1192.09	33						1192.09	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	1	1	04	01	H3817_011_1	7	Preferred Generic	4	01	3	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					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												
H3817	011	1	1	04	01	H3817_011_1	7	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	60.00					13.00	26.00	39.00					13.00	26.00	0.00																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	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					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												
H3817	011	1	1	04	01	H3817_011_1	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1011.47	28						1011.47	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	2	1	04	01	H3817_011_2	7	Preferred Generic	4	01	3	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					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												
H3817	011	2	1	04	01	H3817_011_2	7	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	60.00					13.00	26.00	39.00					13.00	26.00	0.00																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	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					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												
H3817	011	2	1	04	01	H3817_011_2	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1011.47	28						1011.47	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	4	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H3822	001	0	1	01	01	H3822_001_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H3822	001	0	1	01	01	H3822_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	6	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H3822	002	0	1	01	01	H3822_002_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				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												
H3822	002	0	1	01	01	H3822_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	4	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H3822	007	0	1	02	01	H3822_007_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H3822	007	0	1	02	01	H3822_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	5	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	5	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H3822	008	0	1	02	01	H3822_008_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H3822	008	0	1	02	01	H3822_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	012	0	1	01	01	H3822_012_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	012	0	1	01	01	H3822_012_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H3822	012	0	1	01	01	H3822_012_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	012	0	1	01	01	H3822_012_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				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												
H3822	012	0	1	01	01	H3822_012_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	012	0	1	01	01	H3822_012_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	013	0	1	01	01	H3822_013_0	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	013	0	1	01	01	H3822_013_0	4	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H3822	013	0	1	01	01	H3822_013_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	013	0	1	01	01	H3822_013_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H3822	013	0	1	01	01	H3822_013_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	013	0	1	01	01	H3822_013_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	014	0	1	01	01	H3822_014_0	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	014	0	1	01	01	H3822_014_0	4	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H3822	014	0	1	01	01	H3822_014_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	014	0	1	01	01	H3822_014_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				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												
H3822	014	0	1	01	01	H3822_014_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	014	0	1	01	01	H3822_014_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	015	0	1	01	01	H3822_015_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	015	0	1	01	01	H3822_015_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H3822	015	0	1	01	01	H3822_015_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	015	0	1	01	01	H3822_015_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				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												
H3822	015	0	1	01	01	H3822_015_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	015	0	1	01	01	H3822_015_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												
H3832	007	0	1	04	01	H3832_007_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	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	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	8	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3832	008	0	1	04	01	H3832_008_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	11.00	11.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			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	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.50	9.00	13.50																			4.50	4.50	4.50																4.50				4.50		0.15			0.15			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	12.00	12.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3832	010	0	1	04	01	H3832_010_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	11.00	11.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			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	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	6	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3864	006	0	1	01	01	H3864_006_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											67.89	33	33	33				74.83	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											63.84	33						51.19	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	4	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	014	0	1	02	01	H3864_014_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.81	33	33	33				67.10	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											68.83	33						56.08	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	4	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	021	0	1	01	01	H3864_021_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.96	33	33	33				84.31	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											85.83	28						74.75	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	4	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	024	0	1	02	01	H3864_024_0	6	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	6	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	6	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	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											97.38	31	31	31				83.09	30	30	30										31	31	31				30	30	30			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											70.93	31						78.69	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	6	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	6	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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.04	32	32	32				92.48	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											106.88	26						94.73	26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	5	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	5	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	029	0	1	02	01	H3864_029_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					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	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	Preferred Brand	4	10	1	2	3	1		111	01		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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.12	33	33	33				80.44	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	029	0	1	02	01	H3864_029_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											93.78	30						82.19	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	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	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	032	0	1	01	01	H3864_032_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											75.15	33	33	33				77.50	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											68.31	33						53.24	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	5	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	5	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	033	0	1	02	01	H3864_033_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					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												
H3864	033	0	1	02	01	H3864_033_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					9.00	18.00	27.00											17.00	34.00	51.00				9.00	18.00	18.00				17.00				17.00			0.57	0.30		0.57	0.30	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	033	0	1	02	01	H3864_033_0	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	02	01	H3864_033_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.91	33	33	33				76.16	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	02	01	H3864_033_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											64.86	33						53.38	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	033	0	1	02	01	H3864_033_0	6	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	033	0	1	02	01	H3864_033_0	6	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	034	0	1	02	01	H3864_034_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					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												
H3864	034	0	1	02	01	H3864_034_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					9.00	18.00	27.00											17.00	34.00	51.00				9.00	18.00	18.00				17.00				17.00			0.57	0.30		0.57	0.30	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	034	0	1	02	01	H3864_034_0	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	034	0	1	02	01	H3864_034_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											84.40	33	33	33				84.13	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	034	0	1	02	01	H3864_034_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											75.73	33						67.50	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	034	0	1	02	01	H3864_034_0	5	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	02	01	H3864_034_0	5	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	036	0	1	01	01	H3864_036_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	036	0	1	01	01	H3864_036_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	036	0	1	01	01	H3864_036_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.06	33	33	33				81.51	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	036	0	1	01	01	H3864_036_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											80.14	29						72.64	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	036	0	1	01	01	H3864_036_0	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	036	0	1	01	01	H3864_036_0	4	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	037	0	1	01	01	H3864_037_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					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												
H3864	037	0	1	01	01	H3864_037_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					10.00	20.00	30.00											17.00	34.00	51.00				10.00	20.00	20.00				17.00				17.00			0.57	0.33		0.57	0.33	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	037	0	1	01	01	H3864_037_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	037	0	1	01	01	H3864_037_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.92	33	33	33				75.90	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											75.30	33						61.95	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	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	037	0	1	01	01	H3864_037_0	4	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	040	0	1	01	01	H3864_040_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					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												
H3864	040	0	1	01	01	H3864_040_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					9.00	18.00	27.00											17.00	34.00	51.00				9.00	18.00	18.00				17.00				17.00			0.57	0.30		0.57	0.30	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											72.50	33	33	33				76.62	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											65.31	33						53.37	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	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	4	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	041	0	1	01	01	H3864_041_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	041	0	1	01	01	H3864_041_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	041	0	1	01	01	H3864_041_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											66.00	33	33	33				69.43	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											70.72	33						59.75	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	041	0	1	01	01	H3864_041_0	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	041	0	1	01	01	H3864_041_0	4	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	042	0	1	01	01	H3864_042_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	042	0	1	01	01	H3864_042_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	042	0	1	01	01	H3864_042_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	042	0	1	01	01	H3864_042_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											71.66	33	33	33				72.41	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	042	0	1	01	01	H3864_042_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											73.14	29						56.34	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	042	0	1	01	01	H3864_042_0	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	042	0	1	01	01	H3864_042_0	4	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	043	0	1	01	01	H3864_043_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	043	0	1	01	01	H3864_043_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	043	0	1	01	01	H3864_043_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	043	0	1	01	01	H3864_043_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				98.91	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	043	0	1	01	01	H3864_043_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				86.11	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	043	0	1	01	01	H3864_043_0	7	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	043	0	1	01	01	H3864_043_0	7	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3890	001	0	1	04	01	H3890_001_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	4.00	6.00	8.00																			4.00	6.00	8.00																4.00				4.00		0.13			0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	001	0	1	04	01	H3890_001_0	5	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	001	0	1	04	01	H3890_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	001	0	1	04	01	H3890_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	6	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				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	6	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	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	004	0	1	04	01	H3890_004_0	5	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												
H3890	004	0	1	04	01	H3890_004_0	5	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	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	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	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	5	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	006	0	1	01	01	H3907_006_0	6	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	006	0	1	01	01	H3907_006_0	6	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	006	0	1	01	01	H3907_006_0	6	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					47.00	94.00	129.50													141.00						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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1530.00	33						857.51	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	029	0	1	01	01	H3907_029_0	7	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	029	0	1	01	01	H3907_029_0	7	Preferred Generic	4	11	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H3907	029	0	1	01	01	H3907_029_0	7	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	029	0	1	01	01	H3907_029_0	7	Generic	4	11	1	2	2	3		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H3907	029	0	1	01	01	H3907_029_0	7	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					47.00	94.00	129.50													141.00						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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1004.22	33						883.63	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	037	0	1	01	01	H3907_037_0	7	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	037	0	1	01	01	H3907_037_0	7	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	037	0	1	01	01	H3907_037_0	7	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					47.00	94.00	129.50													141.00						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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1071.52	33						952.41	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	045	0	1	01	01	H3907_045_0	7	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	045	0	1	01	01	H3907_045_0	7	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	045	0	1	01	01	H3907_045_0	7	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					47.00	94.00	129.50													141.00						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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1121.90	33						855.12	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	046	0	1	01	01	H3907_046_0	7	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	046	0	1	01	01	H3907_046_0	7	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	046	0	1	01	01	H3907_046_0	7	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					47.00	94.00	129.50													141.00						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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1089.54	33						947.59	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_0	7	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_0	7	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_0	7	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					47.00	94.00	129.50													141.00						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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1040.51	33						735.79	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_0	7	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_0	7	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_0	7	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					47.00	94.00	129.50													141.00						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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											744.91	33						807.79	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	051	0	1	01	01	H3907_051_0	7	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	051	0	1	01	01	H3907_051_0	7	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	051	0	1	01	01	H3907_051_0	7	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					47.00	94.00	129.50													141.00						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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1340.92	33						1044.28	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_0	7	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_0	7	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_0	7	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					47.00	94.00	129.50													141.00						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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											812.45	33						1060.12	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	054	0	1	01	01	H3907_054_0	6	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	054	0	1	01	01	H3907_054_0	6	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	054	0	1	01	01	H3907_054_0	6	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					47.00	94.00	129.50													141.00						117.50				47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	054	0	1	01	01	H3907_054_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	054	0	1	01	01	H3907_054_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1071.28	33						953.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	055	0	1	01	01	H3907_055_0	6	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	055	0	1	01	01	H3907_055_0	6	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	055	0	1	01	01	H3907_055_0	6	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					47.00	94.00	129.50													141.00						117.50				47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	055	0	1	01	01	H3907_055_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	055	0	1	01	01	H3907_055_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1071.28	33						953.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	056	0	1	01	01	H3907_056_0	6	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	056	0	1	01	01	H3907_056_0	6	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	056	0	1	01	01	H3907_056_0	6	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					47.00	94.00	129.50													141.00						117.50				47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	056	0	1	01	01	H3907_056_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	056	0	1	01	01	H3907_056_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1071.28	33						953.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												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	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	2	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	2	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	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	014	0	1	04	01	H3909_014_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	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	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	2	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	2	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	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	015	0	1	04	01	H3909_015_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	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	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	015	0	1	04	01	H3909_015_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	016	0	1	04	01	H3909_016_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	016	0	1	04	01	H3909_016_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	20.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	016	0	1	04	01	H3909_016_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	016	0	1	04	01	H3909_016_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	016	0	1	04	01	H3909_016_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	017	0	1	04	01	H3909_017_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	017	0	1	04	01	H3909_017_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	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	017	0	1	04	01	H3909_017_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	017	0	1	04	01	H3909_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	017	0	1	04	01	H3909_017_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												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	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	Preferred Generic	4	01	1	2	1	3		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	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							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	6	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							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					95.00		285.00							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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1157.78	33						1157.78	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	Preferred Generic	4	01	1	2	1	3		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	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							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	6	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							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					95.00		285.00							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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1281.67	33						1281.67	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	Preferred Generic	4	01	1	2	1	3		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	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							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	6	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							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					95.00		285.00							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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1359.13	33						1359.13	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	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							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					95.00		285.00							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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1519.75	33						1519.75	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	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							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					95.00		285.00							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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1417.41	33						1417.41	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	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							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					95.00		285.00							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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1120.96	33						1120.96	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	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							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					95.00		285.00							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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1032.84	33						1032.84	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	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							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					95.00		285.00							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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1330.25	33						1330.25	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	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							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					95.00		285.00							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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1297.93	33						1297.93	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	1	1	04	01	H3916_034_1	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1252.52	33						1252.52	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	3	1	04	01	H3916_034_3	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1252.52	33						1252.52	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	4	1	04	01	H3916_034_4	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1252.52	33						1252.52	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	5	1	04	01	H3916_034_5	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1252.52	33						1252.52	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								20.00		60.00					5.00		15.00							0.00																20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1398.99	33						1398.99	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								20.00		60.00					5.00		15.00							0.00																20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1398.99	33						1398.99	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	4	1	04	01	H3916_035_4	6	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							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	4	1	04	01	H3916_035_4	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								20.00		60.00					5.00		15.00							0.00																20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	4	1	04	01	H3916_035_4	6	Preferred Brand	4	11	1	2	3	1		110	01	100		1				31		90	1	2			90				31		31								47.00		141.00					47.00		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	4	1	04	01	H3916_035_4	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	4	1	04	01	H3916_035_4	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1398.99	33						1398.99	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	036	0	1	04	01	H3916_036_0	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1407.00	33						1407.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	1	1	04	01	H3916_037_1	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											906.14	33						906.14	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	2	1	04	01	H3916_037_2	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											906.14	33						906.14	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	3	1	04	01	H3916_037_3	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											906.14	33						906.14	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	4	1	04	01	H3916_037_4	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											906.14	33						906.14	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	038	0	1	04	01	H3916_038_0	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1137.31	33						1137.31	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	039	0	1	04	01	H3916_039_0	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1452.23	33						1452.23	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	1	1	04	01	H3916_041_1	6	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							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	1	1	04	01	H3916_041_1	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					7.00		21.00							0.00																15.00				15.00			0.48	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	1	1	04	01	H3916_041_1	6	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							120.00																47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	1	1	04	01	H3916_041_1	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	041	1	1	04	01	H3916_041_1	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											974.58	33						974.58	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	2	1	04	01	H3916_041_2	6	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							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	2	1	04	01	H3916_041_2	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					7.00		21.00							0.00																15.00				15.00			0.48	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	2	1	04	01	H3916_041_2	6	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							120.00																47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	2	1	04	01	H3916_041_2	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	041	2	1	04	01	H3916_041_2	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											974.58	33						974.58	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	5	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					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												
H3923	013	0	1	04	01	H3923_013_0	5	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	013	0	1	04	01	H3923_013_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					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, Select Care Drugs												
H3923	013	0	1	04	01	H3923_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					93.00	186.00	279.00					93.00	186.00	279.00																100.00				100.00			3.33	3.10	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	013	0	1	04	01	H3923_013_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	017	0	1	04	01	H3923_017_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3923	017	0	1	04	01	H3923_017_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					5.00	10.00	15.00					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												
H3923	017	0	1	04	01	H3923_017_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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, Select Care Drugs												
H3923	017	0	1	04	01	H3923_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					93.00	186.00	279.00					93.00	186.00	279.00																100.00				100.00			3.33	3.10	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	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	017	0	1	04	01	H3923_017_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	028	0	1	04	01	H3923_028_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	028	0	1	04	01	H3923_028_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	028	0	1	04	01	H3923_028_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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, Select Care Drugs												
H3923	028	0	1	04	01	H3923_028_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					93.00	186.00	279.00					93.00	186.00	279.00																100.00				100.00			3.33	3.10	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	Specialty Tier	4	11	1	1	5	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												
H3923	028	0	1	04	01	H3923_028_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	029	0	1	04	01	H3923_029_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					8.00	16.00	24.00																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												
H3923	029	0	1	04	01	H3923_029_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	36.00					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, Select Care Drugs												
H3923	029	0	1	04	01	H3923_029_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	029	0	1	04	01	H3923_029_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					93.00	186.00	279.00					93.00	186.00	279.00																100.00				100.00			3.33	3.10	3.10			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	029	0	1	04	01	H3923_029_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	029	0	1	04	01	H3923_029_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	030	0	1	04	01	H3923_030_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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, Select Care Drugs												
H3923	030	0	1	04	01	H3923_030_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	030	0	1	04	01	H3923_030_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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, Select Care Drugs												
H3923	030	0	1	04	01	H3923_030_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					93.00	186.00	279.00					93.00	186.00	279.00																100.00				100.00			3.33	3.10	3.10			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	030	0	1	04	01	H3923_030_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	030	0	1	04	01	H3923_030_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3924	059	21	1	04	01	H3924_059_21	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	21	1	04	01	H3924_059_21	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	21	1	04	01	H3924_059_21	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	20.00	40.00	50.00																			0.00	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												
H3924	059	21	1	04	01	H3924_059_21	5	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	117.50																			47.00	70.50	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	21	1	04	01	H3924_059_21	5	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	250.00																			100.00	150.00	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	21	1	04	01	H3924_059_21	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	21	1	04	01	H3924_059_21	5	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	21	1	04	01	H3924_059_21	5	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	22	1	04	01	H3924_059_22	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	22	1	04	01	H3924_059_22	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	22	1	04	01	H3924_059_22	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	20.00	40.00	50.00																			0.00	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												
H3924	059	22	1	04	01	H3924_059_22	5	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	117.50																			47.00	70.50	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	22	1	04	01	H3924_059_22	5	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	250.00																			100.00	150.00	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	22	1	04	01	H3924_059_22	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	22	1	04	01	H3924_059_22	5	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	22	1	04	01	H3924_059_22	5	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	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	21	1	04	01	H3924_062_21	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	062	21	1	04	01	H3924_062_21	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	12.50																			0.00	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	5	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	117.50																			47.00	70.50	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	5	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	250.00																			100.00	150.00	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	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	21	1	04	01	H3924_062_21	5	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	5	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	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	22	1	04	01	H3924_062_22	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	062	22	1	04	01	H3924_062_22	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	12.50																			0.00	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	5	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	117.50																			47.00	70.50	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	5	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	250.00																			100.00	150.00	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	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	22	1	04	01	H3924_062_22	5	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	5	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	23	1	04	01	H3924_062_23	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	23	1	04	01	H3924_062_23	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	062	23	1	04	01	H3924_062_23	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	12.50																			0.00	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	23	1	04	01	H3924_062_23	5	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	117.50																			47.00	70.50	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	23	1	04	01	H3924_062_23	5	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	250.00																			100.00	150.00	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	23	1	04	01	H3924_062_23	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	23	1	04	01	H3924_062_23	5	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	23	1	04	01	H3924_062_23	5	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	065	0	1	04	01	H3924_065_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	065	0	1	04	01	H3924_065_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	065	0	1	04	01	H3924_065_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	20.00	40.00	50.00																			0.00	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												
H3924	065	0	1	04	01	H3924_065_0	5	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	117.50																			47.00	70.50	70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	065	0	1	04	01	H3924_065_0	5	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	250.00																			100.00	150.00	150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	065	0	1	04	01	H3924_065_0	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	065	0	1	04	01	H3924_065_0	5	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	065	0	1	04	01	H3924_065_0	5	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	066	0	1	04	01	H3924_066_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	066	0	1	04	01	H3924_066_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	066	0	1	04	01	H3924_066_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	12.50																			0.00	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	066	0	1	04	01	H3924_066_0	5	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	117.50																			47.00	70.50	70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	066	0	1	04	01	H3924_066_0	5	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	250.00																			100.00	150.00	150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	066	0	1	04	01	H3924_066_0	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	066	0	1	04	01	H3924_066_0	5	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	066	0	1	04	01	H3924_066_0	5	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	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3928	001	0	1	01	01	H3928_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											838.52	30						436.28	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											770.64	30						398.86	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											979.04	33						582.98	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	064	0	1	02	01	H3931_064_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	064	0	1	02	01	H3931_064_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_064_0	2	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					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												
H3931	064	0	1	02	01	H3931_064_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3931_064_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	064	0	1	02	01	H3931_064_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	064	0	1	02	01	H3931_064_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1260.82	33						373.96	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H3931	070	0	1	01	01	H3931_070_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1031.53	33						447.86	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H3931	091	0	1	01	01	H3931_091_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											859.39	33						353.89	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	092	0	1	01	01	H3931_092_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	092	0	1	01	01	H3931_092_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	092	0	1	01	01	H3931_092_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3931	092	0	1	01	01	H3931_092_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	092	0	1	01	01	H3931_092_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	092	0	1	01	01	H3931_092_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											805.39	31						354.23	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	093	0	1	01	01	H3931_093_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	093	0	1	01	01	H3931_093_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H3931	093	0	1	01	01	H3931_093_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	093	0	1	01	01	H3931_093_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	093	0	1	01	01	H3931_093_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											823.31	33						408.76	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	094	0	1	02	01	H3931_094_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	094	0	1	02	01	H3931_094_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_094_0	2	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					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												
H3931	094	0	1	02	01	H3931_094_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3931_094_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	094	0	1	02	01	H3931_094_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	094	0	1	02	01	H3931_094_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											971.83	31						466.59	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	095	0	1	02	01	H3931_095_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	095	0	1	02	01	H3931_095_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_095_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	095	0	1	02	01	H3931_095_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3931_095_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	095	0	1	02	01	H3931_095_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	095	0	1	02	01	H3931_095_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											728.11	33						394.35	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	096	0	1	02	01	H3931_096_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	096	0	1	02	01	H3931_096_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_096_0	5	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					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												
H3931	096	0	1	02	01	H3931_096_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	096	0	1	02	01	H3931_096_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	096	0	1	02	01	H3931_096_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	096	0	1	02	01	H3931_096_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											811.33	28						390.32	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	097	0	1	01	01	H3931_097_0	2	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	097	0	1	01	01	H3931_097_0	2	Generic	3	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					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												
H3931	097	0	1	01	01	H3931_097_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	097	0	1	01	01	H3931_097_0	2	Non-Preferred Drug	3	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	097	0	1	01	01	H3931_097_0	2	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											814.03	27						261.85	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	02	01	H3931_098_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	02	01	H3931_098_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_098_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	02	01	H3931_098_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3931_098_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	02	01	H3931_098_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	02	01	H3931_098_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											892.68	33						416.75	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	099	0	1	02	01	H3931_099_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	099	0	1	02	01	H3931_099_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_099_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	099	0	1	02	01	H3931_099_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3931_099_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	099	0	1	02	01	H3931_099_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	099	0	1	02	01	H3931_099_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1112.28	33						670.91	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	100	0	1	02	01	H3931_100_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	100	0	1	02	01	H3931_100_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_100_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	100	0	1	02	01	H3931_100_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3931_100_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	100	0	1	02	01	H3931_100_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	100	0	1	02	01	H3931_100_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											853.47	33						480.89	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	101	0	1	02	01	H3931_101_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	101	0	1	02	01	H3931_101_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_101_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	101	0	1	02	01	H3931_101_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3931_101_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	101	0	1	02	01	H3931_101_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	101	0	1	02	01	H3931_101_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											925.34	33						503.76	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	102	0	1	01	01	H3931_102_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	102	0	1	01	01	H3931_102_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	102	0	1	01	01	H3931_102_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	102	0	1	01	01	H3931_102_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	102	0	1	01	01	H3931_102_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1086.78	33						499.60	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H3931	104	0	1	01	01	H3931_104_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											791.70	31						451.46	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H3931	105	0	1	01	01	H3931_105_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											802.34	30						327.92	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	107	0	1	02	01	H3931_107_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	107	0	1	02	01	H3931_107_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_107_0	2	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					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												
H3931	107	0	1	02	01	H3931_107_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3931_107_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	107	0	1	02	01	H3931_107_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	107	0	1	02	01	H3931_107_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											929.84	30						349.94	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	108	0	1	01	01	H3931_108_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	108	0	1	01	01	H3931_108_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H3931	108	0	1	01	01	H3931_108_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	108	0	1	01	01	H3931_108_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	108	0	1	01	01	H3931_108_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											924.94	30						408.43	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	109	0	1	02	01	H3931_109_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	109	0	1	02	01	H3931_109_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_109_0	3	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					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												
H3931	109	0	1	02	01	H3931_109_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3931_109_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	109	0	1	02	01	H3931_109_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	109	0	1	02	01	H3931_109_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											889.42	30						419.25	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	112	0	1	01	01	H3931_112_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	112	0	1	01	01	H3931_112_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H3931	112	0	1	01	01	H3931_112_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	112	0	1	01	01	H3931_112_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	112	0	1	01	01	H3931_112_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											935.87	30						487.75	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	115	0	1	02	01	H3931_115_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	115	0	1	02	01	H3931_115_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_115_0	2	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					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												
H3931	115	0	1	02	01	H3931_115_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3931_115_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	115	0	1	02	01	H3931_115_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	115	0	1	02	01	H3931_115_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											827.28	31						444.72	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	118	0	1	01	01	H3931_118_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	118	0	1	01	01	H3931_118_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	118	0	1	01	01	H3931_118_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	118	0	1	01	01	H3931_118_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	118	0	1	01	01	H3931_118_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											906.46	30						541.77	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	124	0	1	02	01	H3931_124_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	124	0	1	02	01	H3931_124_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_124_0	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	124	0	1	02	01	H3931_124_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3931_124_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	124	0	1	02	01	H3931_124_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	124	0	1	02	01	H3931_124_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											979.00	33						501.71	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	126	0	1	02	01	H3931_126_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	126	0	1	02	01	H3931_126_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_126_0	2	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					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												
H3931	126	0	1	02	01	H3931_126_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3931_126_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	126	0	1	02	01	H3931_126_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	126	0	1	02	01	H3931_126_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											810.02	33						385.92	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	129	0	1	02	01	H3931_129_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	129	0	1	02	01	H3931_129_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_129_0	3	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					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												
H3931	129	0	1	02	01	H3931_129_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3931_129_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	129	0	1	02	01	H3931_129_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	129	0	1	02	01	H3931_129_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											789.84	31						378.60	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	133	0	1	01	01	H3931_133_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	133	0	1	01	01	H3931_133_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	133	0	1	01	01	H3931_133_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	133	0	1	01	01	H3931_133_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	133	0	1	01	01	H3931_133_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											844.03	29						436.99	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	134	0	1	02	01	H3931_134_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	134	0	1	02	01	H3931_134_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_134_0	2	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					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												
H3931	134	0	1	02	01	H3931_134_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H3931_134_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	134	0	1	02	01	H3931_134_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	134	0	1	02	01	H3931_134_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											708.61	30						338.63	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	140	0	1	01	01	H3931_140_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	140	0	1	01	01	H3931_140_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H3931	140	0	1	01	01	H3931_140_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	140	0	1	01	01	H3931_140_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	140	0	1	01	01	H3931_140_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											861.35	30						393.39	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	143	0	1	02	01	H3931_143_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3931	143	0	1	02	01	H3931_143_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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		
H3931	143	0	1	02	01	H3931_143_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3931	143	0	1	02	01	H3931_143_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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		
H3931	143	0	1	02	01	H3931_143_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	143	0	1	02	01	H3931_143_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	143	0	1	02	01	H3931_143_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											941.08	33						459.86	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	013	0	1	01	01	H3949_013_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											929.68	33						727.31	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	024	0	1	01	01	H3949_024_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											786.43	33						656.69	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	4	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	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	030	0	1	01	01	H3949_030_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											809.32	33						798.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	031	0	1	01	01	H3949_031_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	031	0	1	01	01	H3949_031_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	031	0	1	01	01	H3949_031_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											882.94	33						700.36	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	032	0	1	01	01	H3949_032_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	032	0	1	01	01	H3949_032_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	032	0	1	01	01	H3949_032_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											706.61	33						702.24	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	033	0	1	01	01	H3949_033_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	033	0	1	01	01	H3949_033_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	033	0	1	01	01	H3949_033_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											705.04	33						727.02	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	034	0	1	01	01	H3949_034_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	034	0	1	01	01	H3949_034_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	034	0	1	01	01	H3949_034_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											809.32	33						798.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	035	0	1	01	01	H3949_035_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	3	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	3	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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											805.02	33						795.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	4	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					9.00	18.00	18.00					9.00	18.00	18.00																20.00				20.00			0.67	0.30	0.30			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	2	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	2	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	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	2	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	2	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	053	0	1	02	01	H3952_053_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					.00	.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	053	0	1	02	01	H3952_053_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	20.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	053	0	1	02	01	H3952_053_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	053	0	1	02	01	H3952_053_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	053	0	1	02	01	H3952_053_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	054	0	1	02	01	H3952_054_0	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					.00	.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	054	0	1	02	01	H3952_054_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	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	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	2	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	2	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	2	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	055	0	1	01	01	H3952_055_0	2	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	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	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	2	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	2	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	056	0	1	01	01	H3952_056_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	056	0	1	01	01	H3952_056_0	3	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	20.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	056	0	1	01	01	H3952_056_0	3	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	056	0	1	01	01	H3952_056_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	056	0	1	01	01	H3952_056_0	3	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3954	157	21	1	01	01	H3954_157_21	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	21	1	01	01	H3954_157_21	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	21	1	01	01	H3954_157_21	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	20.00	40.00	50.00																			0.00	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	21	1	01	01	H3954_157_21	5	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	117.50																			47.00	70.50	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	21	1	01	01	H3954_157_21	5	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	250.00																			100.00	150.00	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	21	1	01	01	H3954_157_21	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	21	1	01	01	H3954_157_21	5	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	21	1	01	01	H3954_157_21	5	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	22	1	01	01	H3954_157_22	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	22	1	01	01	H3954_157_22	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	22	1	01	01	H3954_157_22	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	20.00	40.00	50.00																			0.00	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	22	1	01	01	H3954_157_22	5	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	117.50																			47.00	70.50	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	22	1	01	01	H3954_157_22	5	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	250.00																			100.00	150.00	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	22	1	01	01	H3954_157_22	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	22	1	01	01	H3954_157_22	5	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	22	1	01	01	H3954_157_22	5	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	23	1	01	01	H3954_157_23	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	23	1	01	01	H3954_157_23	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	23	1	01	01	H3954_157_23	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	20.00	40.00	50.00																			0.00	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	23	1	01	01	H3954_157_23	5	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	117.50																			47.00	70.50	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	23	1	01	01	H3954_157_23	5	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	250.00																			100.00	150.00	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	23	1	01	01	H3954_157_23	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	23	1	01	01	H3954_157_23	5	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	23	1	01	01	H3954_157_23	5	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	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	13	1	01	01	H3954_158_13	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	13	1	01	01	H3954_158_13	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	20.00	40.00	50.00																			0.00	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	158	13	1	01	01	H3954_158_13	5	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	117.50																			47.00	70.50	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	5	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	250.00																			100.00	150.00	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	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	13	1	01	01	H3954_158_13	5	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	5	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	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	14	1	01	01	H3954_158_14	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	14	1	01	01	H3954_158_14	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	20.00	40.00	50.00																			0.00	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	158	14	1	01	01	H3954_158_14	5	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	117.50																			47.00	70.50	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	5	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	250.00																			100.00	150.00	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	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	14	1	01	01	H3954_158_14	5	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	5	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	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	160	0	1	01	01	H3954_160_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	160	0	1	01	01	H3954_160_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	20.00	40.00	50.00																			0.00	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	5	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	117.50																			47.00	70.50	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	5	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	250.00																			100.00	150.00	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	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	160	0	1	01	01	H3954_160_0	5	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	5	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	161	0	1	01	01	H3954_161_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	161	0	1	01	01	H3954_161_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	7.50																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	161	0	1	01	01	H3954_161_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	20.00	40.00	50.00																			0.00	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	161	0	1	01	01	H3954_161_0	5	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	117.50																			47.00	70.50	70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	161	0	1	01	01	H3954_161_0	5	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	250.00																			100.00	150.00	150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	161	0	1	01	01	H3954_161_0	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	161	0	1	01	01	H3954_161_0	5	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	161	0	1	01	01	H3954_161_0	5	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	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							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	02	01	H3957_031_0	7	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								19.00		57.00					13.00		39.00							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	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							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	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							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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1257.53	33						1257.53	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	6	Preferred Generic	4	01	1	2	1	3		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	039	0	1	01	01	H3957_039_0	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								19.00		57.00					13.00		39.00							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	6	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							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					95.00		285.00							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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1350.94	33						1350.94	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	1	1	01	01	H3957_042_1	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1452.94	33						1452.94	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	2	1	01	01	H3957_042_2	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1452.94	33						1452.94	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	4	1	01	01	H3957_042_4	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								7.00		21.00					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												
H3957	042	4	1	01	01	H3957_042_4	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1452.94	33						1452.94	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	5	1	01	01	H3957_042_5	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								7.00		21.00					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												
H3957	042	5	1	01	01	H3957_042_5	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1452.94	33						1452.94	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	1	1	02	01	H3957_044_1	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	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							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					95.00		285.00							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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1237.76	33						1237.76	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	4	1	02	01	H3957_044_4	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	4	1	02	01	H3957_044_4	6	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							27.00																19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	4	1	02	01	H3957_044_4	6	Preferred Brand	4	11	1	2	3	1		110	01	100		1				31		90	1	2			90				31		31								47.00		141.00					45.00		135.00							115.00																47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	4	1	02	01	H3957_044_4	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					95.00		285.00							275.00																100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	4	1	02	01	H3957_044_4	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1237.76	33						1237.76	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	6	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	44.00		132.00																					110.00																44.00				44.00		1.42						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1389.95	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	6	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	44.00		132.00																					110.00																44.00				44.00		1.42						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1389.95	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	6	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	1	1	02	01	H3957_046_1	6	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	6	Generic	4	01	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	1	1	02	01	H3957_046_1	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1229.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	6	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	6	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	2	1	02	01	H3957_046_2	6	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	6	Generic	4	01	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	2	1	02	01	H3957_046_2	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1229.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	1	1	01	01	H3957_047_1	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1082.85	33						1082.85	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	2	1	01	01	H3957_047_2	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1082.85	33						1082.85	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H3959	001	0	1	01	01	H3959_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3959	001	0	1	01	01	H3959_001_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											944.57	33						528.24	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H3959	002	0	1	01	01	H3959_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3959	002	0	1	01	01	H3959_002_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											902.16	33						790.97	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H3959	010	0	1	01	01	H3959_010_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3959	010	0	1	01	01	H3959_010_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											901.21	33						635.63	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H3959	011	0	1	01	01	H3959_011_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3959	011	0	1	01	01	H3959_011_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1087.01	33						596.78	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	032	0	1	02	01	H3959_032_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	032	0	1	02	01	H3959_032_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3959_032_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	032	0	1	02	01	H3959_032_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3959_032_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	032	0	1	02	01	H3959_032_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	032	0	1	02	01	H3959_032_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1060.05	33						590.01	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	033	0	1	01	01	H3959_033_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	033	0	1	01	01	H3959_033_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1041.50	33						469.24	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	035	0	1	01	01	H3959_035_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3959	035	0	1	01	01	H3959_035_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3959	035	0	1	01	01	H3959_035_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	035	0	1	01	01	H3959_035_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											45.39	25	25	25				45.79	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	035	0	1	01	01	H3959_035_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											665.71	27						437.44	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	036	0	1	01	01	H3959_036_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3959	036	0	1	01	01	H3959_036_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3959	036	0	1	01	01	H3959_036_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	036	0	1	01	01	H3959_036_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											42.19	25	25	25				44.36	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	036	0	1	01	01	H3959_036_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											707.48	26						456.78	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	037	0	1	02	01	H3959_037_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	037	0	1	02	01	H3959_037_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3959_037_0	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	037	0	1	02	01	H3959_037_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H3959_037_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	037	0	1	02	01	H3959_037_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	037	0	1	02	01	H3959_037_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											909.91	33						681.45	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	039	0	1	02	01	H3959_039_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	039	0	1	02	01	H3959_039_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	039	0	1	02	01	H3959_039_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	039	0	1	02	01	H3959_039_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	039	0	1	02	01	H3959_039_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	039	0	1	02	01	H3959_039_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	039	0	1	02	01	H3959_039_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											695.98	33						694.18	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	045	0	1	01	01	H3959_045_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	045	0	1	01	01	H3959_045_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	045	0	1	01	01	H3959_045_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H3959	045	0	1	01	01	H3959_045_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3959	045	0	1	01	01	H3959_045_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											933.16	33						485.10	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	046	0	1	01	01	H3959_046_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	046	0	1	01	01	H3959_046_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	046	0	1	01	01	H3959_046_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H3959	046	0	1	01	01	H3959_046_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H3959	046	0	1	01	01	H3959_046_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1178.91	33						510.24	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	047	0	1	01	01	H3959_047_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	047	0	1	01	01	H3959_047_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	047	0	1	01	01	H3959_047_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H3959	047	0	1	01	01	H3959_047_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H3959	047	0	1	01	01	H3959_047_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1136.38	33						486.03	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	049	0	1	01	01	H3959_049_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	049	0	1	01	01	H3959_049_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	049	0	1	01	01	H3959_049_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H3959	049	0	1	01	01	H3959_049_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H3959	049	0	1	01	01	H3959_049_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											997.17	33						486.99	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	051	0	1	01	01	H3959_051_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	051	0	1	01	01	H3959_051_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	051	0	1	01	01	H3959_051_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H3959	051	0	1	01	01	H3959_051_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H3959	051	0	1	01	01	H3959_051_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											946.71	33						442.99	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	052	0	1	01	01	H3959_052_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	052	0	1	01	01	H3959_052_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	052	0	1	01	01	H3959_052_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	052	0	1	01	01	H3959_052_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	052	0	1	01	01	H3959_052_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	052	0	1	01	01	H3959_052_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	052	0	1	01	01	H3959_052_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1070.29	33						659.57	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	053	0	1	01	01	H3959_053_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	053	0	1	01	01	H3959_053_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	053	0	1	01	01	H3959_053_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H3959	053	0	1	01	01	H3959_053_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H3959	053	0	1	01	01	H3959_053_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1111.60	33						498.90	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	055	0	1	02	01	H3959_055_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	055	0	1	02	01	H3959_055_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3959_055_0	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	055	0	1	02	01	H3959_055_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	055	0	1	02	01	H3959_055_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	055	0	1	02	01	H3959_055_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	055	0	1	02	01	H3959_055_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1004.33	33						408.78	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	058	0	1	01	01	H3959_058_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	058	0	1	01	01	H3959_058_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	058	0	1	01	01	H3959_058_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	058	0	1	01	01	H3959_058_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	058	0	1	01	01	H3959_058_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	058	0	1	01	01	H3959_058_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	058	0	1	01	01	H3959_058_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1005.79	33						404.56	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	063	0	1	01	01	H3959_063_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H3959	063	0	1	01	01	H3959_063_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H3959	063	0	1	01	01	H3959_063_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	063	0	1	01	01	H3959_063_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											45.69	25	25	25				42.66	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	063	0	1	01	01	H3959_063_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											614.45	25						397.26	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	10.50	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	001	0	1	01	01	H3962_001_0	4	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	10.50	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3962	001	0	1	01	01	H3962_001_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	12.00	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												
H3962	001	0	1	01	01	H3962_001_0	4	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	12.00	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										1		
H3962	001	0	1	01	01	H3962_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	70.50	94.00					40.00	60.00	80.00					40.00	60.00	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												
H3962	001	0	1	01	01	H3962_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	150.00	200.00					93.00	139.50	186.00					93.00	139.50	186.00																100.00				100.00			3.33	3.10	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	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	001	0	1	01	01	H3962_001_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	10.50	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	001	0	1	01	01	H3962_001_0	4	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	10.50	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3962	004	0	1	01	01	H3962_004_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	004	0	1	01	01	H3962_004_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					5.00	10.00	15.00					5.00	10.00	15.00																15.00				15.00			0.50	0.17	0.17			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	004	0	1	01	01	H3962_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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, Select Care Drugs												
H3962	004	0	1	01	01	H3962_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					93.00	186.00	279.00					93.00	186.00	279.00																100.00				100.00			3.33	3.10	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	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	004	0	1	01	01	H3962_004_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	007	0	1	01	01	H3962_007_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	007	0	1	01	01	H3962_007_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					5.00	10.00	15.00					5.00	10.00	15.00																15.00				15.00			0.50	0.17	0.17			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	007	0	1	01	01	H3962_007_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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, Select Care Drugs												
H3962	007	0	1	01	01	H3962_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					93.00	186.00	279.00					93.00	186.00	279.00																100.00				100.00			3.33	3.10	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	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	007	0	1	01	01	H3962_007_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	021	0	1	01	01	H3962_021_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	021	0	1	01	01	H3962_021_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					5.00	10.00	15.00					5.00	10.00	15.00																15.00				15.00			0.50	0.17	0.17			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	021	0	1	01	01	H3962_021_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	021	0	1	01	01	H3962_021_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					93.00	186.00	279.00					93.00	186.00	279.00																100.00				100.00			3.33	3.10	3.10			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	021	0	1	01	01	H3962_021_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	021	0	1	01	01	H3962_021_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3975	001	0	1	04	01	H3975_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3975	001	0	1	04	01	H3975_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3975	001	0	1	04	01	H3975_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H3975	001	0	1	04	01	H3975_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.14	45	45	45				94.74	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3975	001	0	1	04	01	H3975_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3975	001	0	1	04	01	H3975_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3975	001	0	1	04	01	H3975_001_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H3979	001	0	1	01	01	H3979_001_0	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	6	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H3979	001	0	1	01	01	H3979_001_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H3979	001	0	1	01	01	H3979_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	009	0	1	01	01	H4003_009_0	9	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	009	0	1	01	01	H4003_009_0	9	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	009	0	1	01	01	H4003_009_0	9	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	009	0	1	01	01	H4003_009_0	9	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, Select Care Drugs												
H4003	009	0	1	01	01	H4003_009_0	9	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	20.00		40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	009	0	1	01	01	H4003_009_0	9	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				302.53	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	009	0	1	01	01	H4003_009_0	9	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	019	0	1	02	01	H4003_019_0	9	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	9	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	9	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	02	01	H4003_019_0	9	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	019	0	1	02	01	H4003_019_0	9	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				2	2			90				30		31	1.00		2.00																					2.00																1.00				1.00		0.03						0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	02	01	H4003_019_0	9	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	1.00		2.00																					2.00																1.00				1.00		0.03						0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	02	01	H4003_019_0	9	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				173.39	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	9	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	9	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	9	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	9	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	034	0	1	02	01	H4003_034_0	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				202.66	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	044	0	1	02	01	H4003_044_0	10	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	10	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	10	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	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				214.61	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	051	0	1	02	01	H4003_051_0	12	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	12	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	12	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	12	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	12	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	6.00		12.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	051	0	1	02	01	H4003_051_0	12	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	12	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				240.39	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	052	0	1	01	01	H4003_052_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	052	0	1	01	01	H4003_052_0	8	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	052	0	1	01	01	H4003_052_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	052	0	1	01	01	H4003_052_0	8	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	052	0	1	01	01	H4003_052_0	8	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, Select Care Drugs												
H4003	052	0	1	01	01	H4003_052_0	8	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, Select Care Drugs												
H4003	052	0	1	01	01	H4003_052_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				290.26	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	052	0	1	01	01	H4003_052_0	8	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	056	0	1	02	01	H4004_056_0	11	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	11	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	11	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	11	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	11	Preferred Brand	4	10	3	2	3	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												
H4004	056	0	1	02	01	H4004_056_0	11	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												
H4004	056	0	1	02	01	H4004_056_0	11	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				237.47	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	063	0	1	02	01	H4004_063_0	9	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												
H4004	063	0	1	02	01	H4004_063_0	9	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		
H4004	063	0	1	02	01	H4004_063_0	9	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	3.00		6.00																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	063	0	1	02	01	H4004_063_0	9	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	3.00		6.00																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4004	063	0	1	02	01	H4004_063_0	9	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												
H4004	063	0	1	02	01	H4004_063_0	9	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												
H4004	063	0	1	02	01	H4004_063_0	9	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				238.86	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	064	0	1	02	01	H4004_064_0	9	Preferred Generic	4	01	1	2	1	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												
H4004	064	0	1	02	01	H4004_064_0	9	Preferred Generic	4	01	1	2	1	3	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										2		
H4004	064	0	1	02	01	H4004_064_0	9	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	11.00		22.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	064	0	1	02	01	H4004_064_0	9	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	11.00		22.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4004	064	0	1	02	01	H4004_064_0	9	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												
H4004	064	0	1	02	01	H4004_064_0	9	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												
H4004	064	0	1	02	01	H4004_064_0	9	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				238.86	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	065	0	1	02	01	H4004_065_0	8	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	065	0	1	02	01	H4004_065_0	8	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	065	0	1	02	01	H4004_065_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	065	0	1	02	01	H4004_065_0	8	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4004	065	0	1	02	01	H4004_065_0	8	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												
H4004	065	0	1	02	01	H4004_065_0	8	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												
H4004	065	0	1	02	01	H4004_065_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				184.26	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	7	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		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	012	0	1	01	01	H4007_012_0	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	012	0	1	01	01	H4007_012_0	7	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	3	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	3	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		14.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	020	0	1	01	01	H4007_020_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		35.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	020	0	1	01	01	H4007_020_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	020	0	1	01	01	H4007_020_0	3	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	6	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	6	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	021	0	1	01	01	H4007_021_0	6	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	021	0	1	01	01	H4007_021_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		35.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	021	0	1	01	01	H4007_021_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	021	0	1	01	01	H4007_021_0	6	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	7	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	7	Preferred Brand	4	11	1	2	3	1		111	01	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	7	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	7	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	9	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	009	0	1	04	01	H4036_009_0	9	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	9	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	9	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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	7	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	7	Preferred Brand	4	11	1	2	3	1		111	01	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H4036	020	0	1	04	01	H4036_020_0	7	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	020	0	1	04	01	H4036_020_0	7	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	7	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	7	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	7	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	7	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	023	0	1	04	01	H4036_023_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H4036	023	0	1	04	01	H4036_023_0	7	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	023	0	1	04	01	H4036_023_0	7	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	023	0	1	04	01	H4036_023_0	7	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	023	0	1	04	01	H4036_023_0	7	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	023	0	1	04	01	H4036_023_0	7	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	023	0	1	04	01	H4036_023_0	7	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	025	0	1	04	01	H4036_025_0	8	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	025	0	1	04	01	H4036_025_0	8	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	025	0	1	04	01	H4036_025_0	8	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	025	0	1	04	01	H4036_025_0	8	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	025	0	1	04	01	H4036_025_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	025	0	1	04	01	H4036_025_0	8	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	025	0	1	04	01	H4036_025_0	8	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		
H4073	001	0	1	01	01	H4073_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4073	001	0	1	01	01	H4073_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H4073	001	0	1	01	01	H4073_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H4073	001	0	1	01	01	H4073_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.61	47	47	47				95.37	45	45	45										47	47	47				45	45	45			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4073	001	0	1	01	01	H4073_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4073	001	0	1	01	01	H4073_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4073	002	0	1	01	01	H4073_002_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4073	002	0	1	01	01	H4073_002_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	11.00	22.00	33.00																									11.00	22.00	33.00				11.00	22.00	0.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4073	002	0	1	01	01	H4073_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4073	002	0	1	01	01	H4073_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.44	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4073	002	0	1	01	01	H4073_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4073	002	0	1	01	01	H4073_002_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4091	003	0	1	04	01	H4091_003_0	7	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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	7	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	7	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	7	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	7	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	8	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	8	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	8	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	8	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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				552.33	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	002	0	1	02	01	H4140_002_0	8	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	8	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	8	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	8	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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				722.79	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	004	0	1	02	01	H4140_004_0	8	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	8	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	8	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	8	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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1037.85	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	005	0	1	02	01	H4140_005_0	8	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				638.87	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	006	0	1	02	01	H4140_006_0	7	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	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	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	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	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				120.31	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	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				55.72	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				622.20	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	007	0	1	02	01	H4140_007_0	7	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	7	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	7	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	7	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	7	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				120.31	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	7	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				55.72	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	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				622.20	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	009	0	1	02	01	H4140_009_0	7	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	009	0	1	02	01	H4140_009_0	7	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	009	0	1	02	01	H4140_009_0	7	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	009	0	1	02	01	H4140_009_0	7	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	009	0	1	02	01	H4140_009_0	7	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	009	0	1	02	01	H4140_009_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	009	0	1	02	01	H4140_009_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				575.02	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	010	0	1	02	01	H4140_010_0	7	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	010	0	1	02	01	H4140_010_0	7	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	010	0	1	02	01	H4140_010_0	7	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	010	0	1	02	01	H4140_010_0	7	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	010	0	1	02	01	H4140_010_0	7	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	010	0	1	02	01	H4140_010_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	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	010	0	1	02	01	H4140_010_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				769.89	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	011	0	1	02	01	H4140_011_0	7	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	011	0	1	02	01	H4140_011_0	7	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	011	0	1	02	01	H4140_011_0	7	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	011	0	1	02	01	H4140_011_0	7	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	011	0	1	02	01	H4140_011_0	7	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	011	0	1	02	01	H4140_011_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	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												
H4140	011	0	1	02	01	H4140_011_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				858.48	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_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					0.00		0.00											10.00		30.00				0.00		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	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												
H4141	003	0	1	01	01	H4141_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												
H4141	003	0	1	01	01	H4141_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_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												
H4141	015	0	1	01	01	H4141_015_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	4	1	01	01	H4141_017_4	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	4	1	01	01	H4141_017_4	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	4	1	01	01	H4141_017_4	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	4	1	01	01	H4141_017_4	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	4	1	01	01	H4141_017_4	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	5	1	01	01	H4141_017_5	3	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	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	5	1	01	01	H4141_017_5	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	10	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	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	10	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	10	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	10	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	10	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	10	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	10	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	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	10	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	10	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	10	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	10	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	10	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	020	0	1	02	01	H4152_020_0	11	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								8.00	16.00	24.00					0.00	0.00	0.00						0.00	0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	020	0	1	02	01	H4152_020_0	11	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								16.00	32.00	48.00					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	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	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	Specialty Tier	4	11	1	1	5	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	021	0	1	01	01	H4152_021_0	7	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												
H4152	021	0	1	01	01	H4152_021_0	7	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		
H4152	021	0	1	01	01	H4152_021_0	7	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												
H4152	021	0	1	01	01	H4152_021_0	7	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		
H4152	021	0	1	01	01	H4152_021_0	7	Preferred Brand	4	11	1	1	3	1	111		01	101		1	30	60	90				1	2		60	90				30		31				59.29	25	25	25																			25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	021	0	1	01	01	H4152_021_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		01	101		1	30	60	90				1	2		60	90				30		31				74.47	25	25	25																			25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	021	0	1	01	01	H4152_021_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	008	0	1	01	01	H4198_008_0	8	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			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												
H4198	008	0	1	01	01	H4198_008_0	8	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		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4198	008	0	1	01	01	H4198_008_0	8	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		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	008	0	1	01	01	H4198_008_0	8	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		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4198	008	0	1	01	01	H4198_008_0	8	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	008	0	1	01	01	H4198_008_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		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	008	0	1	01	01	H4198_008_0	8	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1202.00	31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	009	0	1	01	01	H4198_009_0	10	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												
H4198	009	0	1	01	01	H4198_009_0	10	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		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4198	009	0	1	01	01	H4198_009_0	10	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		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	009	0	1	01	01	H4198_009_0	10	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		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4198	009	0	1	01	01	H4198_009_0	10	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	009	0	1	01	01	H4198_009_0	10	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	009	0	1	01	01	H4198_009_0	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1278.00	31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	5	Preferred Generic	3	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	5.00		12.50																			5.00		12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	5	Generic	3	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	20.00		50.00																			20.00		50.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	5	Preferred Brand	3	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												
H4213	017	1	1	09	04	H4213_017_1	5	Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				98.53	41		41																		41		41															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	5	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	5	Preferred Generic	3	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	5.00		12.50																			5.00		12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	5	Generic	3	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	20.00		50.00																			20.00		50.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	5	Preferred Brand	3	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												
H4213	017	5	1	09	04	H4213_017_5	5	Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				98.53	41		41																		41		41															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	5	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	5	Preferred Generic	3	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	5.00		12.50																			5.00		12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	5	Generic	3	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	20.00		50.00																			20.00		50.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	5	Preferred Brand	3	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												
H4213	017	6	1	09	04	H4213_017_6	5	Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				98.53	41		41																		41		41															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	5	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	6	Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	6.00	12.00	18.00																					18.00																6.00				6.00		0.20						0.19	Generic, Brand												
H4227	001	0	1	01	01	H4227_001_0	6	Brand	2	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	Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	6.50	13.00	19.50																					19.50																6.50				6.50		0.22						0.21	Generic, Brand												
H4227	002	0	1	01	01	H4227_002_0	6	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												
H4232	002	0	1	01	01	H4232_002_0	2	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4232	002	0	1	01	01	H4232_002_0	2	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 Drug, Specialty Tier												
H4232	002	0	1	01	01	H4232_002_0	2	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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												
H4232	002	0	1	01	01	H4232_002_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	98.00	196.00	294.00																			98.00	196.00	294.00																	98.00			98.00		3.27			3.27			3.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4232	002	0	1	01	01	H4232_002_0	2	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31					33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	7	Preferred Generic	2	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					5.00	7.50	10.00													15.00						10.00				10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	7	Generic	2	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	60.00					10.00	15.00	20.00													25.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	7	Preferred Brand	2	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								40.00	77.00	114.00					25.00	32.50	40.00													45.00						40.00				40.00				25.00			1.33	0.83				0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	7	Non-Preferred Drug	2	11	1	1	4	1		111	01		100	1				30	60	90	1	2						90	30		31											56.64	49	49	49				61.32	49	49	49												49						49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	7	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											560.02	25						517.69	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	004	0	1	01	01	H4279_004_0	6	Preferred Generic	2	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					5.00	7.50	10.00													15.00						10.00				10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	004	0	1	01	01	H4279_004_0	6	Generic	2	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	60.00					10.00	15.00	20.00													25.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	004	0	1	01	01	H4279_004_0	6	Preferred Brand	2	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								40.00	77.00	114.00					25.00	32.50	40.00													45.00						40.00				40.00				25.00			1.33	0.83				0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	004	0	1	01	01	H4279_004_0	6	Non-Preferred Drug	2	11	1	1	4	1		111	01		100	1				30	60	90	1	2						90	30		31											56.64	49	49	49				61.31	49	49	49												49						49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	004	0	1	01	01	H4279_004_0	6	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											560.02	25						517.69	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4286	001	0	1	01	01	H4286_001_0	6	Generic	4	01	3	2	1	1		111	01			1				30	60	90	2	1							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 Brand, Specialty Tier												
H4286	001	0	1	01	01	H4286_001_0	6	Generic	4	01	3	2	1	3		111	01			1				30	60	90	2	1							30		31								5.00	10.00	15.00					0.00	0.00	0.00																							5.00				5.00			0.16	0.00				0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H4286	001	0	1	01	01	H4286_001_0	6	Preferred Brand	4	10	1	2	2	1		111	01			1				30	60	90	2	1							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 Brand, Specialty Tier												
H4286	001	0	1	01	01	H4286_001_0	6	Non-Preferred Brand	4	10	1	2	3	1		010	01			1				30											30		31								50.00							40.00																									50.00				50.00			1.67	1.33				1.61	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4286	001	0	1	01	01	H4286_001_0	6	Specialty Tier	4	11	1	1	4	1		010	01			1				30											30		31											390.44	33						1032.10	33																							33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4286	002	0	1	01	01	H4286_002_0	9	Generic	4	01	1	2	1	1		111	01			1				30	60	90	2	1							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 Brand, Specialty Tier, Supplemental Drugs												
H4286	002	0	1	01	01	H4286_002_0	9	Preferred Brand	4	10	1	1	2	1		111	01			1				30	60	90	2	1							30		31											100.78	25	25	25				97.61	25	25	25																					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H4286	002	0	1	01	01	H4286_002_0	9	Non-Preferred Brand	4	10	1	1	3	1		010	01			1				30											30		31											98.57	36						99.23	34																							36			36								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H4286	002	0	1	01	01	H4286_002_0	9	Specialty Tier	4	11	1	1	4	1		010	01			1				30											30		31											269.89	25						511.57	25																							25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H4286	002	0	1	01	01	H4286_002_0	9	Supplemental Drugs	4	11	2	2	5	1		010	01			1				30											30		31								5.00							0.00																									5.00				5.00			0.17	0.00				0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H4286	002	0	1	01	01	H4286_002_0	9	Supplemental Drugs	4	11	2	2	5	3		010	01			1				30											30		31								5.00							0.00																									5.00				5.00			0.17	0.00				0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H4286	003	0	1	01	01	H4286_003_0	4	Generic	4	01	3	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4286	003	0	1	01	01	H4286_003_0	4	Generic	4	01	3	2	1	3		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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H4286	003	0	1	01	01	H4286_003_0	4	Preferred Brand	4	10	1	2	2	1		111	01			1				30	60	90	2	1							30		31								47.00	94.00	141.00					47.00	94.00	141.00																							47.00				47.00			1.57	1.57				1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4286	003	0	1	01	01	H4286_003_0	4	Non-Preferred Brand	4	10	1	2	3	1		010	01			1				30											30		31								100.00							97.00																									100.00				100.00			3.33	3.23				3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4286	003	0	1	01	01	H4286_003_0	4	Specialty Tier	4	11	1	1	4	1		010	01			1				30											30		31											389.26	33						1029.99	33																							33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4304	001	0	1	04	01	H4304_001_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	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												
H4304	001	0	1	04	01	H4304_001_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				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												
H4304	001	0	1	04	01	H4304_001_0	7	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																			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												
H4304	001	0	1	04	01	H4304_001_0	7	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												
H4304	001	0	1	04	01	H4304_001_0	7	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	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	001	0	1	01	01	H4343_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	0.00				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	001	0	1	01	01	H4343_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H4343	001	0	1	01	01	H4343_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H4343	001	0	1	01	01	H4343_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	001	0	1	01	01	H4343_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	002	0	1	01	01	H4343_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	0.00				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	002	0	1	01	01	H4343_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H4343	002	0	1	01	01	H4343_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H4343	002	0	1	01	01	H4343_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	002	0	1	01	01	H4343_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	003	0	1	01	01	H4343_003_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H4343	003	0	1	01	01	H4343_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	003	0	1	01	01	H4343_003_0	4	Generic	4	11	1	2	2	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											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4343	003	0	1	01	01	H4343_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H4343	003	0	1	01	01	H4343_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H4343	003	0	1	01	01	H4343_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	003	0	1	01	01	H4343_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H4343	004	0	1	01	01	H4343_004_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	004	0	1	01	01	H4343_004_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H4343	004	0	1	01	01	H4343_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	004	0	1	01	01	H4343_004_0	4	Generic	4	11	1	2	2	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											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4343	004	0	1	01	01	H4343_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H4343	004	0	1	01	01	H4343_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H4343	004	0	1	01	01	H4343_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	004	0	1	01	01	H4343_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H4343	005	0	1	01	01	H4343_005_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	005	0	1	01	01	H4343_005_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	9.00	18.00	27.00																									9.00	18.00	27.00				9.00	18.00	0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	005	0	1	01	01	H4343_005_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	005	0	1	01	01	H4343_005_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.91	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	005	0	1	01	01	H4343_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	005	0	1	01	01	H4343_005_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	006	0	1	01	01	H4343_006_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	006	0	1	01	01	H4343_006_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	006	0	1	01	01	H4343_006_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	006	0	1	01	01	H4343_006_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.91	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	006	0	1	01	01	H4343_006_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	006	0	1	01	01	H4343_006_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	7	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	7	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	7	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	7	Generic	4	01	1	2	2	3		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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	001	0	1	01	01	H4346_001_0	7	Preferred Brand	4	11	1	2	3	1		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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	7	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	7	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	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	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	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	005	0	1	01	01	H4346_005_0	6	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	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	Specialty Tier	4	11	1	1	5	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	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	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	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	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	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	006	0	1	01	01	H4346_006_0	6	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H4346	006	0	1	01	01	H4346_006_0	6	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	Specialty Tier	4	11	1	1	5	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	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	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	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	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	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	008	0	1	01	01	H4346_008_0	6	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	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	Specialty Tier	4	11	1	1	5	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	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	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	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					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, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	6	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					0.00	0.00	0.00																15.50				15.50			0.52	0.35	0.00			0.46	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	6	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	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	Specialty Tier	4	11	1	1	5	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	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												
H4346	010	0	1	01	01	H4346_010_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	010	0	1	01	01	H4346_010_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	7	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	7	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	7	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	7	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	7	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	7	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	012	0	1	01	01	H4346_012_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H4346	012	0	1	01	01	H4346_012_0	8	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					0.00	0.00	0.00																13.00				13.00			0.43	0.27	0.00			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	012	0	1	01	01	H4346_012_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	012	0	1	01	01	H4346_012_0	8	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	8	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	014	0	1	01	01	H4346_014_0	6	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	014	0	1	01	01	H4346_014_0	6	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					0.00	0.00	0.00																4.00				4.00			0.13	0.13	0.00			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	014	0	1	01	01	H4346_014_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	014	0	1	01	01	H4346_014_0	6	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	6	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	9	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	9	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	9	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												
H4346	017	0	1	01	01	H4346_017_0	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	019	0	1	01	01	H4346_019_0	8	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	8	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	8	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					0.00	0.00	0.00																13.00				13.00			0.43	0.27	0.00			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	019	0	1	01	01	H4346_019_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	022	0	1	01	01	H4346_022_0	9	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	9	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	9	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	022	0	1	01	01	H4346_022_0	9	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			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	9	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	022	0	1	01	01	H4346_022_0	9	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H4346	022	0	1	01	01	H4346_022_0	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	022	0	1	01	01	H4346_022_0	9	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	9	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	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	023	0	1	01	01	H4346_023_0	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	023	0	1	01	01	H4346_023_0	9	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	023	0	1	01	01	H4346_023_0	9	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	9	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	9	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	9	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	9	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	9	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	8	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	8	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	8	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												
H4346	024	0	1	01	01	H4346_024_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	025	0	1	01	01	H4346_025_0	6	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	6	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	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.50	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	025	0	1	01	01	H4346_025_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	026	0	1	01	01	H4346_026_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	6	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	026	0	1	01	01	H4346_026_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	6	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	026	0	1	01	01	H4346_026_0	6	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											80.13	25	25	25				100.17	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											67.42	25	25	25				67.42	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	6	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	026	0	1	01	01	H4346_026_0	6	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		
H4346	029	0	1	01	01	H4346_029_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H4346	029	0	1	01	01	H4346_029_0	8	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					0.00	0.00	0.00																13.00				13.00			0.43	0.27	0.00			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	029	0	1	01	01	H4346_029_0	8	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	029	0	1	01	01	H4346_029_0	8	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	029	0	1	01	01	H4346_029_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	029	0	1	01	01	H4346_029_0	8	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	029	0	1	01	01	H4346_029_0	8	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		
H4407	026	0	1	01	01	H4407_026_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	4.00											7.00	14.00	21.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	026	0	1	01	01	H4407_026_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	20.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	026	0	1	01	01	H4407_026_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	026	0	1	01	01	H4407_026_0	4	Non-Preferred Drug	4	11	1	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											876.13	33						681.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	027	0	1	01	01	H4407_027_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	027	0	1	01	01	H4407_027_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	027	0	1	01	01	H4407_027_0	4	Non-Preferred Drug	4	11	1	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											993.38	33						703.49	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	028	0	1	01	01	H4407_028_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	028	0	1	01	01	H4407_028_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	20.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	028	0	1	01	01	H4407_028_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	028	0	1	01	01	H4407_028_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	250.00					100.00	200.00	250.00											100.00	200.00	250.00				100.00	200.00	250.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	028	0	1	01	01	H4407_028_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											913.15	33						761.08	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	9	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												
H4461	022	0	1	01	01	H4461_022_0	9	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												
H4461	022	0	1	01	01	H4461_022_0	9	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	9	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	9	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	01	01	H4461_025_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	01	01	H4461_029_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	01	01	H4461_029_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	01	01	H4461_030_1	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	01	01	H4461_030_2	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	01	01	H4461_030_3	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	01	01	H4461_031_1	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	01	01	H4461_031_1	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	3	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	01	01	H4461_031_2	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	01	01	H4461_031_3	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	01	01	H4461_031_3	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	01	01	H4461_034_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	01	01	H4461_034_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	01	01	H4461_034_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	01	01	H4461_034_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	01	01	H4461_034_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	01	01	H4461_035_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	01	01	H4461_035_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	01	01	H4461_035_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	01	01	H4461_035_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	01	01	H4461_035_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	01	01	H4461_036_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	01	01	H4461_036_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	01	01	H4461_036_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	01	01	H4461_036_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	01	01	H4461_036_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	037	0	1	01	01	H4461_037_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	037	0	1	01	01	H4461_037_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	037	0	1	01	01	H4461_037_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	01	01	H4461_037_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	037	0	1	01	01	H4461_037_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	038	0	1	01	01	H4461_038_0	6	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	038	0	1	01	01	H4461_038_0	6	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	038	0	1	01	01	H4461_038_0	6	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	038	0	1	01	01	H4461_038_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	038	0	1	01	01	H4461_038_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4490	002	0	1	01	01	H4490_002_0	2	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	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	2	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 Drug, Specialty Tier												
H4490	002	0	1	01	01	H4490_002_0	2	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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												
H4490	002	0	1	01	01	H4490_002_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	98.00	196.00	294.00																			98.00	196.00	294.00																	98.00			98.00		3.27			3.27			3.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4490	002	0	1	01	01	H4490_002_0	2	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31					33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	9	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	1	1	04	01	H4497_001_1	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	1	1	04	01	H4497_001_1	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											91.15	50		50				83.00	50		50										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	9	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												
H4497	001	2	1	04	01	H4497_001_2	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	9	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	2	1	04	01	H4497_001_2	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	2	1	04	01	H4497_001_2	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											91.15	50		50				83.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	3	1	04	01	H4497_001_3	9	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	3	1	04	01	H4497_001_3	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	3	1	04	01	H4497_001_3	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	3	1	04	01	H4497_001_3	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	3	1	04	01	H4497_001_3	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											91.15	50		50				83.00	50		50										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	9	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												
H4497	002	1	1	04	01	H4497_002_1	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		12.00					0.00		0.00											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	9	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								6.00		12.00					0.00		0.00											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	1	1	04	01	H4497_002_1	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	1	1	04	01	H4497_002_1	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											79.01	50		50				72.78	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												32							32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		12.00					0.00		0.00											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	9	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								6.00		12.00					0.00		0.00											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	2	1	04	01	H4497_002_2	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	2	1	04	01	H4497_002_2	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											79.01	50		50				72.78	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												32							32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	3	1	04	01	H4497_002_3	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	3	1	04	01	H4497_002_3	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	3	1	04	01	H4497_002_3	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	3	1	04	01	H4497_002_3	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	3	1	04	01	H4497_002_3	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	3	1	04	01	H4497_002_3	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											79.01	50		50				72.78	50		50										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	9	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												
H4497	003	1	1	04	01	H4497_003_1	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		12.00					0.00		0.00											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	9	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								6.00		12.00					0.00		0.00											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	1	1	04	01	H4497_003_1	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	1	1	04	01	H4497_003_1	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											77.87	50		50				73.11	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												32							32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		12.00					0.00		0.00											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	9	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								6.00		12.00					0.00		0.00											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	2	1	04	01	H4497_003_2	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	2	1	04	01	H4497_003_2	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											77.87	50		50				73.11	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												32							32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	3	1	04	01	H4497_003_3	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	3	1	04	01	H4497_003_3	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	3	1	04	01	H4497_003_3	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	3	1	04	01	H4497_003_3	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	3	1	04	01	H4497_003_3	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	3	1	04	01	H4497_003_3	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											77.87	50		50				73.11	50		50										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	9	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												
H4497	005	1	1	04	01	H4497_005_1	10	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											11.00		28.00				3.00		7.00				12.00				12.00			0.40	0.13		0.37	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	1	1	04	01	H4497_005_1	10	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											11.00		28.00				3.00		7.00				12.00				12.00			0.40	0.13		0.37	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4497	005	1	1	04	01	H4497_005_1	10	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								16.00		40.00					8.00		20.00											15.00		38.00				6.00		15.00				16.00				16.00			0.53	0.27		0.50	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	1	1	04	01	H4497_005_1	10	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								16.00		40.00					8.00		20.00											15.00		38.00				6.00		15.00				16.00				16.00			0.53	0.27		0.50	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4497	005	1	1	04	01	H4497_005_1	10	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	1	1	04	01	H4497_005_1	10	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											72.01	50		50				71.33	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	1	1	04	01	H4497_005_1	10	Specialty Tier	4	11	1	1	5	1		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												
H4497	005	1	1	04	01	H4497_005_1	10	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											7.00		18.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	1	1	04	01	H4497_005_1	10	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											7.00		18.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4497	005	2	1	04	01	H4497_005_2	11	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											11.00		28.00				3.00		7.00				12.00				12.00			0.40	0.13		0.37	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	2	1	04	01	H4497_005_2	11	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											11.00		28.00				3.00		7.00				12.00				12.00			0.40	0.13		0.37	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4497	005	2	1	04	01	H4497_005_2	11	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								16.00		40.00					8.00		20.00											15.00		38.00				6.00		15.00				16.00				16.00			0.53	0.27		0.50	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	2	1	04	01	H4497_005_2	11	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								16.00		40.00					8.00		20.00											15.00		38.00				6.00		15.00				16.00				16.00			0.53	0.27		0.50	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4497	005	2	1	04	01	H4497_005_2	11	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	2	1	04	01	H4497_005_2	11	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											72.01	50		50				71.33	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	2	1	04	01	H4497_005_2	11	Specialty Tier	4	11	1	1	5	1		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												
H4497	005	2	1	04	01	H4497_005_2	11	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											7.00		18.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	2	1	04	01	H4497_005_2	11	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											7.00		18.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4506	003	0	1	01	01	H4506_003_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4506	003	0	1	01	01	H4506_003_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H4506	003	0	1	01	01	H4506_003_0	4	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					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												
H4506	003	0	1	01	01	H4506_003_0	4	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	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										1		
H4506	003	0	1	01	01	H4506_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H4506	003	0	1	01	01	H4506_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								80.00	160.00	240.00					70.00	140.00	210.00											80.00	160.00	240.00				70.00	140.00	140.00				80.00				80.00			2.67	2.33		2.67	2.33	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4506	003	0	1	01	01	H4506_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4506	003	0	1	01	01	H4506_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4506	003	0	1	01	01	H4506_003_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H4506	029	0	1	02	01	H4506_029_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4506	029	0	1	02	01	H4506_029_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H4506	029	0	1	02	01	H4506_029_0	4	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					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												
H4506	029	0	1	02	01	H4506_029_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					30.00	60.00	90.00											40.00	80.00	120.00				30.00	60.00	60.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4506	029	0	1	02	01	H4506_029_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H4506	029	0	1	02	01	H4506_029_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4506	029	0	1	02	01	H4506_029_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4506	029	0	1	02	01	H4506_029_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H4513	026	0	1	01	01	H4513_026_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	3	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	3	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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											672.69	29						512.56	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	Preferred Generic	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											819.54	29						534.73	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					3.00	6.00	6.00											10.00	20.00	20.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					3.00	6.00	6.00											10.00	20.00	20.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	030	0	1	01	01	H4513_030_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					12.00	24.00	24.00											20.00	40.00	40.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					12.00	24.00	24.00											20.00	40.00	40.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	030	0	1	01	01	H4513_030_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											84.64	38	38	38				73.42	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											765.46	29						487.40	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											94.09	40	40	40				81.48	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											781.22	29						684.27	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	037	0	1	01	01	H4513_037_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					10.00	20.00	20.00											20.00	40.00	40.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	037	0	1	01	01	H4513_037_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	037	0	1	01	01	H4513_037_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											84.41	43	43	43				67.40	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											903.36	33						760.06	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	038	0	1	01	01	H4513_038_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.92	47	47	47				71.47	47	47	47										47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											910.01	33						672.12	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	4.00											9.00	18.00	27.00				2.00	4.00	0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	4	Generic	4	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.37	41	41	41				87.80	41	41	41										41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											720.33	29						582.39	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	4.00											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	3	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	3	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	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.37	41	41	41				87.80	41	41	41										41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											720.33	29						582.39	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	047	0	1	01	01	H4513_047_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	047	0	1	01	01	H4513_047_0	4	Non-Preferred Drug	4	11	1	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											765.85	33						847.05	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	048	0	1	01	01	H4513_048_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	048	0	1	01	01	H4513_048_0	4	Non-Preferred Drug	4	11	1	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											738.79	33						657.95	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	1	1	01	01	H4513_049_1	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	10.00											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												
H4513	049	1	1	01	01	H4513_049_1	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	1	1	01	01	H4513_049_1	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											87.02	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												
H4513	049	1	1	01	01	H4513_049_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											915.18	33						758.48	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	2	1	01	01	H4513_049_2	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	10.00											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												
H4513	049	2	1	01	01	H4513_049_2	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	2	1	01	01	H4513_049_2	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											87.02	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												
H4513	049	2	1	01	01	H4513_049_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											915.18	33						758.48	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	050	0	1	01	01	H4513_050_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	050	0	1	01	01	H4513_050_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	050	0	1	01	01	H4513_050_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	050	0	1	01	01	H4513_050_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											97.03	50	50	50				73.42	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											972.05	33						656.23	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	051	0	1	01	01	H4513_051_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	051	0	1	01	01	H4513_051_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	051	0	1	01	01	H4513_051_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	051	0	1	01	01	H4513_051_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											93.99	50	50	50				73.62	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											979.87	33						735.51	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	052	0	1	01	01	H4513_052_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	052	0	1	01	01	H4513_052_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	052	0	1	01	01	H4513_052_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	052	0	1	01	01	H4513_052_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											79.96	50	50	50				72.68	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											867.01	33						682.33	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	054	0	1	01	01	H4513_054_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	4.00											7.00	14.00	21.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	054	0	1	01	01	H4513_054_0	4	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	054	0	1	01	01	H4513_054_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	054	0	1	01	01	H4513_054_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											864.89	33						589.02	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	057	0	1	01	01	H4513_057_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	4.00											7.00	14.00	21.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	057	0	1	01	01	H4513_057_0	4	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	057	0	1	01	01	H4513_057_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	057	0	1	01	01	H4513_057_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											913.88	33						725.28	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	059	0	1	01	01	H4513_059_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					10.00	20.00	20.00											20.00	40.00	40.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	059	0	1	01	01	H4513_059_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	059	0	1	01	01	H4513_059_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											86.45	49	49	49				68.18	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											913.15	33						761.08	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	1	1	01	01	H4513_061_1	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	3	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	3	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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											756.45	29						622.11	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	2	1	01	01	H4513_061_2	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	3	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	3	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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											756.45	29						622.11	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	3	1	01	01	H4513_061_3	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	3	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	3	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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											756.45	29						622.11	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	064	0	1	01	01	H4513_064_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	064	0	1	01	01	H4513_064_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	064	0	1	01	01	H4513_064_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	064	0	1	01	01	H4513_064_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	064	0	1	01	01	H4513_064_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	064	0	1	01	01	H4513_064_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											756.45	29						622.11	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	066	0	1	01	01	H4513_066_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	066	0	1	01	01	H4513_066_0	3	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	066	0	1	01	01	H4513_066_0	3	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	066	0	1	01	01	H4513_066_0	3	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	066	0	1	01	01	H4513_066_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	066	0	1	01	01	H4513_066_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											756.45	29						622.11	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	2	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												
H4514	007	0	1	01	01	H4514_007_0	2	Preferred Generic	4	01	1	2	1	3	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										1		
H4514	007	0	1	01	01	H4514_007_0	2	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												
H4514	007	0	1	01	01	H4514_007_0	2	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
H4514	007	0	1	01	01	H4514_007_0	2	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												
H4514	007	0	1	01	01	H4514_007_0	2	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												
H4514	007	0	1	01	01	H4514_007_0	2	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												
H4514	014	0	1	02	01	H4514_014_0	3	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												
H4514	014	0	1	02	01	H4514_014_0	3	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		
H4514	014	0	1	02	01	H4514_014_0	3	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												
H4514	014	0	1	02	01	H4514_014_0	3	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										2		2
H4514	014	0	1	02	01	H4514_014_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	014	0	1	02	01	H4514_014_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	014	0	1	02	01	H4514_014_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				352.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	015	0	1	02	01	H4514_015_0	4	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												
H4514	015	0	1	02	01	H4514_015_0	4	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		
H4514	015	0	1	02	01	H4514_015_0	4	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												
H4514	015	0	1	02	01	H4514_015_0	4	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
H4514	015	0	1	02	01	H4514_015_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	015	0	1	02	01	H4514_015_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	015	0	1	02	01	H4514_015_0	4	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												
H4523	001	0	1	01	01	H4523_001_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											677.92	28						362.65	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											932.19	29						689.97	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	020	0	1	01	01	H4523_020_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	020	0	1	01	01	H4523_020_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	020	0	1	01	01	H4523_020_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	020	0	1	01	01	H4523_020_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	020	0	1	01	01	H4523_020_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											778.42	28						379.85	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1051.07	28						560.28	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	024	0	1	01	01	H4523_024_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	024	0	1	01	01	H4523_024_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											833.26	28						588.78	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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	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	001	0	1	01	01	H4527_001_0	4	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	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	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	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	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												
H4527	002	0	1	01	01	H4527_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H4527	002	0	1	01	01	H4527_002_0	3	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	3	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				467.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	3	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	3	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	005	0	1	01	01	H4527_005_0	3	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	005	0	1	01	01	H4527_005_0	3	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	005	0	1	01	01	H4527_005_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	3	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												
H4527	013	0	1	01	01	H4527_013_0	3	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	3	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	013	0	1	01	01	H4527_013_0	3	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	3	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				336.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	02	01	H4527_037_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	02	01	H4527_037_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H4527	037	0	1	02	01	H4527_037_0	3	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	037	0	1	02	01	H4527_037_0	3	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	037	0	1	02	01	H4527_037_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	02	01	H4527_037_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	02	01	H4527_037_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				246.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	039	0	1	01	01	H4527_039_0	3	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	3	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	3	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	3	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	039	0	1	01	01	H4527_039_0	3	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												
H4527	040	0	1	01	01	H4527_040_0	3	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	3	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	3	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	040	0	1	01	01	H4527_040_0	3	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
H4527	040	0	1	01	01	H4527_040_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	040	0	1	01	01	H4527_040_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				254.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	041	0	1	01	01	H4527_041_0	3	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	3	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	3	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	3	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	041	0	1	01	01	H4527_041_0	3	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												
H4527	042	0	1	01	01	H4527_042_0	3	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	3	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	3	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	3	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	042	0	1	01	01	H4527_042_0	3	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												
H4537	001	0	1	04	01	H4537_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4537	001	0	1	04	01	H4537_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H4537	001	0	1	04	01	H4537_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H4537	001	0	1	04	01	H4537_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H4537	001	0	1	04	01	H4537_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4537	001	0	1	04	01	H4537_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4537	002	0	1	04	01	H4537_002_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4537	002	0	1	04	01	H4537_002_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H4537	002	0	1	04	01	H4537_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H4537	002	0	1	04	01	H4537_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H4537	002	0	1	04	01	H4537_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4537	002	0	1	04	01	H4537_002_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4544	001	0	1	04	01	H4544_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4544	001	0	1	04	01	H4544_001_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4544	001	0	1	04	01	H4544_001_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4544	001	0	1	04	01	H4544_001_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4544	001	0	1	04	01	H4544_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						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	Non-Preferred 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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				347.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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	3	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	3	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	010	0	1	01	01	H4590_010_0	3	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	010	0	1	01	01	H4590_010_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	3	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												
H4590	012	0	1	02	01	H4590_012_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	02	01	H4590_012_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	012	0	1	02	01	H4590_012_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	02	01	H4590_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	02	01	H4590_012_0	3	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												
H4590	025	0	1	01	01	H4590_025_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H4590	025	0	1	01	01	H4590_025_0	3	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	3	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				277.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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	3	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	3	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	3	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	3	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	3	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	041	0	1	02	01	H4590_041_0	3	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	041	0	1	02	01	H4590_041_0	3	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	041	0	1	02	01	H4590_041_0	3	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	041	0	1	02	01	H4590_041_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	02	01	H4590_041_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	02	01	H4590_041_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				532.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H4590	042	0	1	02	01	H4590_042_0	3	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	042	0	1	02	01	H4590_042_0	3	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	042	0	1	02	01	H4590_042_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	3	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												
H4590	043	0	1	02	01	H4590_043_0	3	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	043	0	1	02	01	H4590_043_0	3	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	043	0	1	02	01	H4590_043_0	3	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	043	0	1	02	01	H4590_043_0	3	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	043	0	1	02	01	H4590_043_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	043	0	1	02	01	H4590_043_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	043	0	1	02	01	H4590_043_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				408.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	044	0	1	02	01	H4590_044_0	3	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	3	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	3	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												
H4590	044	0	1	02	01	H4590_044_0	3	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
H4590	044	0	1	02	01	H4590_044_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	044	0	1	02	01	H4590_044_0	3	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												
H4590	045	0	1	01	01	H4590_045_0	3	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	045	0	1	01	01	H4590_045_0	3	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	045	0	1	01	01	H4590_045_0	3	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	045	0	1	01	01	H4590_045_0	3	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	045	0	1	01	01	H4590_045_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	045	0	1	01	01	H4590_045_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	045	0	1	01	01	H4590_045_0	3	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												
H4604	003	0	1	01	01	H4604_003_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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	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		
H4604	003	0	1	01	01	H4604_003_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				287.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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	011	0	1	01	01	H4604_011_0	3	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		
H4604	011	0	1	01	01	H4604_011_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				307.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	012	0	1	01	01	H4604_012_0	3	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	012	0	1	01	01	H4604_012_0	3	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		
H4604	012	0	1	01	01	H4604_012_0	3	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	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	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	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	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	013	0	1	01	01	H4604_013_0	3	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	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		
H4604	013	0	1	01	01	H4604_013_0	3	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	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	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	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	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												
H4604	014	0	1	01	01	H4604_014_0	3	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	014	0	1	01	01	H4604_014_0	3	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		
H4604	014	0	1	01	01	H4604_014_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				396.00	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	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	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		
H4604	015	0	1	01	01	H4604_015_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				416.00	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	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	016	0	1	01	01	H4604_016_0	3	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		
H4604	016	0	1	01	01	H4604_016_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				395.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	017	0	1	01	01	H4604_017_0	3	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	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		
H4604	017	0	1	01	01	H4604_017_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				178.00	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	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	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		
H4604	018	0	1	01	01	H4604_018_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											261.00	29						271.00	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	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	Preferred Generic	4	01	1	2	1	3	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										1		
H4604	020	0	1	01	01	H4604_020_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				348.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	022	0	1	01	01	H4604_022_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	022	0	1	01	01	H4604_022_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H4604	022	0	1	01	01	H4604_022_0	3	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	022	0	1	01	01	H4604_022_0	3	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	022	0	1	01	01	H4604_022_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	022	0	1	01	01	H4604_022_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	022	0	1	01	01	H4604_022_0	3	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												
H4604	023	0	1	01	01	H4604_023_0	3	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	023	0	1	01	01	H4604_023_0	3	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		
H4604	023	0	1	01	01	H4604_023_0	3	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												
H4604	023	0	1	01	01	H4604_023_0	3	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
H4604	023	0	1	01	01	H4604_023_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	023	0	1	01	01	H4604_023_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	023	0	1	01	01	H4604_023_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				307.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	7	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					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												
H4605	002	0	1	04	01	H4605_002_0	7	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	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1083.71	30						1083.71	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	7	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					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												
H4605	004	0	1	04	01	H4605_004_0	7	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					8.00	16.00	16.00					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												
H4605	004	0	1	04	01	H4605_004_0	7	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1192.09	33						1192.09	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	007	0	1	04	01	H4605_007_0	7	Preferred Generic	4	01	3	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					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												
H4605	007	0	1	04	01	H4605_007_0	7	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	60.00					13.00	26.00	39.00					13.00	26.00	0.00																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	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					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												
H4605	007	0	1	04	01	H4605_007_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1119.84	31						1119.84	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	008	0	1	04	01	H4605_008_0	7	Preferred Generic	4	01	3	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					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												
H4605	008	0	1	04	01	H4605_008_0	7	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	60.00					13.00	26.00	39.00					13.00	26.00	0.00																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	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					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												
H4605	008	0	1	04	01	H4605_008_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1047.59	29						1047.59	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	009	0	1	04	01	H4605_009_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					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												
H4605	009	0	1	04	01	H4605_009_0	7	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	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1083.71	30						1083.71	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	01	01	H4623_001_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	01	01	H4623_001_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	01	01	H4623_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	01	01	H4623_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	002	0	1	01	01	H4623_002_0	7	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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	002	0	1	01	01	H4623_002_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	002	0	1	01	01	H4623_002_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	001	0	1	01	01	H4624_001_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	001	0	1	01	01	H4624_001_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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		
H4624	001	0	1	01	01	H4624_001_0	8	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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 Brand, Specialty Tier												
H4624	001	0	1	01	01	H4624_001_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	001	0	1	01	01	H4624_001_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	001	0	1	01	01	H4624_001_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	002	0	1	02	01	H4624_002_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	002	0	1	02	01	H4624_002_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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		
H4624	002	0	1	02	01	H4624_002_0	8	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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 Brand, Specialty Tier												
H4624	002	0	1	02	01	H4624_002_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	002	0	1	02	01	H4624_002_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	002	0	1	02	01	H4624_002_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	003	0	1	01	01	H4624_003_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	003	0	1	01	01	H4624_003_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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		
H4624	003	0	1	01	01	H4624_003_0	8	Generic	4	11	3	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	8.00	8.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	003	0	1	01	01	H4624_003_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	003	0	1	01	01	H4624_003_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	003	0	1	01	01	H4624_003_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	006	0	1	01	01	H4624_006_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	006	0	1	01	01	H4624_006_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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		
H4624	006	0	1	01	01	H4624_006_0	8	Generic	4	11	3	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	8.00	8.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	006	0	1	01	01	H4624_006_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	006	0	1	01	01	H4624_006_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	006	0	1	01	01	H4624_006_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	007	0	1	02	01	H4624_007_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	007	0	1	02	01	H4624_007_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4624	007	0	1	02	01	H4624_007_0	8	Generic	4	11	3	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	8.00	8.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	007	0	1	02	01	H4624_007_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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 Brand, Specialty Tier												
H4624	007	0	1	02	01	H4624_007_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	007	0	1	02	01	H4624_007_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	010	0	1	01	01	H4624_010_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	010	0	1	01	01	H4624_010_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4624	010	0	1	01	01	H4624_010_0	8	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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 Brand, Specialty Tier												
H4624	010	0	1	01	01	H4624_010_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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 Brand, Specialty Tier												
H4624	010	0	1	01	01	H4624_010_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	010	0	1	01	01	H4624_010_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	011	0	1	01	01	H4624_011_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	011	0	1	01	01	H4624_011_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4624	011	0	1	01	01	H4624_011_0	8	Generic	4	11	3	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	8.00	8.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	011	0	1	01	01	H4624_011_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	011	0	1	01	01	H4624_011_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	011	0	1	01	01	H4624_011_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	012	0	1	01	01	H4624_012_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	012	0	1	01	01	H4624_012_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4624	012	0	1	01	01	H4624_012_0	8	Generic	4	11	3	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	8.00	8.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	012	0	1	01	01	H4624_012_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	012	0	1	01	01	H4624_012_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	012	0	1	01	01	H4624_012_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	015	0	1	02	01	H4624_015_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	015	0	1	02	01	H4624_015_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4624	015	0	1	02	01	H4624_015_0	8	Generic	4	11	3	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	8.00	8.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	015	0	1	02	01	H4624_015_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	015	0	1	02	01	H4624_015_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	015	0	1	02	01	H4624_015_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	016	0	1	02	01	H4624_016_0	9	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				3.00	23	23	23																		23	23	23															23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	016	0	1	02	01	H4624_016_0	9	Generic	4	11	3	1	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				19.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	016	0	1	02	01	H4624_016_0	9	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				121.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	016	0	1	02	01	H4624_016_0	9	Non-Preferred Brand	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				91.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	016	0	1	02	01	H4624_016_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				613.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	017	0	1	02	01	H4624_017_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	017	0	1	02	01	H4624_017_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4624	017	0	1	02	01	H4624_017_0	8	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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 Brand, Specialty Tier												
H4624	017	0	1	02	01	H4624_017_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	017	0	1	02	01	H4624_017_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	017	0	1	02	01	H4624_017_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	018	0	1	02	01	H4624_018_0	9	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	018	0	1	02	01	H4624_018_0	9	Generic	4	11	3	1	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				21.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	018	0	1	02	01	H4624_018_0	9	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				120.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	018	0	1	02	01	H4624_018_0	9	Non-Preferred Brand	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				89.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	018	0	1	02	01	H4624_018_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				591.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	019	0	1	01	01	H4624_019_0	8	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	019	0	1	01	01	H4624_019_0	8	Generic	4	11	3	1	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				22.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	019	0	1	01	01	H4624_019_0	8	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				121.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	019	0	1	01	01	H4624_019_0	8	Non-Preferred Brand	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				93.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4624	019	0	1	01	01	H4624_019_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				621.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4675	001	0	1	01	01	H4675_001_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4675	001	0	1	01	01	H4675_001_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			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, Select Care Drugs												
H4675	001	0	1	01	01	H4675_001_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4675	001	0	1	01	01	H4675_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4675	001	0	1	01	01	H4675_001_0	6	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, Select Care Drugs												
H4675	001	0	1	01	01	H4675_001_0	6	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4676	001	0	1	01	01	H4676_001_0	6	Preferred Generic	4	11	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	6	Preferred Generic	4	11	1	2	1	3		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										1		
H4676	001	0	1	01	01	H4676_001_0	6	Generic	4	11	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	6	Preferred Brand	4	11	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	6	Non-Preferred Brand	4	11	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	6	Specialty Tier	4	11	1	1	5	1		111	01			1				30	60	90	2	1							30		31											1233.92	33	33	33				585.46	33	33	33																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4699	001	0	1	04	01	H4699_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	001	0	1	04	01	H4699_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H4699	001	0	1	04	01	H4699_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H4699	001	0	1	04	01	H4699_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.76	45	45	45				94.37	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	001	0	1	04	01	H4699_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	001	0	1	04	01	H4699_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	001	0	1	04	01	H4699_001_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H4699	002	0	1	04	01	H4699_002_0	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	002	0	1	04	01	H4699_002_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H4699	002	0	1	04	01	H4699_002_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H4699	002	0	1	04	01	H4699_002_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											93.57	50	50	50				89.83	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	002	0	1	04	01	H4699_002_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	002	0	1	04	01	H4699_002_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	002	0	1	04	01	H4699_002_0	6	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H4699	003	0	1	04	01	H4699_003_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	003	0	1	04	01	H4699_003_0	6	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	7.00	14.00	21.00																									7.00	14.00	21.00				7.00	14.00	0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	003	0	1	04	01	H4699_003_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	003	0	1	04	01	H4699_003_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.67	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	003	0	1	04	01	H4699_003_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	003	0	1	04	01	H4699_003_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	004	0	1	04	01	H4699_004_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	004	0	1	04	01	H4699_004_0	6	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																									14.00	28.00	42.00				14.00	28.00	0.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	004	0	1	04	01	H4699_004_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H4699	004	0	1	04	01	H4699_004_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.10	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	004	0	1	04	01	H4699_004_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	004	0	1	04	01	H4699_004_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	005	0	1	04	01	H4699_005_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	005	0	1	04	01	H4699_005_0	6	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	7.00	14.00	21.00																									7.00	14.00	21.00				7.00	14.00	0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	005	0	1	04	01	H4699_005_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	005	0	1	04	01	H4699_005_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.70	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	005	0	1	04	01	H4699_005_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	005	0	1	04	01	H4699_005_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	001	0	1	01	01	H4709_001_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H4709	001	0	1	01	01	H4709_001_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	001	0	1	01	01	H4709_001_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H4709	001	0	1	01	01	H4709_001_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	20.00		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												
H4709	001	0	1	01	01	H4709_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				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												
H4709	001	0	1	01	01	H4709_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				641.73	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	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H4709	001	0	1	01	01	H4709_001_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4709	011	0	1	01	01	H4709_011_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	011	0	1	01	01	H4709_011_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	20		60																					40																20				20		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	011	0	1	01	01	H4709_011_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				673.31	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	011	0	1	01	01	H4709_011_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4709	025	0	1	01	01	H4709_025_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H4709	025	0	1	01	01	H4709_025_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	025	0	1	01	01	H4709_025_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				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												
H4709	025	0	1	01	01	H4709_025_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	30.00		90.00																					60.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	025	0	1	01	01	H4709_025_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	95.00		285.00																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	025	0	1	01	01	H4709_025_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				673.38	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	025	0	1	01	01	H4709_025_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H4709	025	0	1	01	01	H4709_025_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4709	026	0	1	01	01	H4709_026_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	026	0	1	01	01	H4709_026_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	026	0	1	01	01	H4709_026_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	9		27																					18																9				9		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	026	0	1	01	01	H4709_026_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	026	0	1	01	01	H4709_026_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	026	0	1	01	01	H4709_026_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				673.32	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	026	0	1	01	01	H4709_026_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	026	0	1	01	01	H4709_026_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4709	027	0	1	01	01	H4709_027_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	027	0	1	01	01	H4709_027_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	027	0	1	01	01	H4709_027_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	9		27																					18																9				9		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	027	0	1	01	01	H4709_027_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	027	0	1	01	01	H4709_027_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	90		270																					180																90				90		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	027	0	1	01	01	H4709_027_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				405.87	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	027	0	1	01	01	H4709_027_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	027	0	1	01	01	H4709_027_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4709	029	0	1	01	01	H4709_029_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	029	0	1	01	01	H4709_029_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	029	0	1	01	01	H4709_029_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	15		45																					30																15				15		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	029	0	1	01	01	H4709_029_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	029	0	1	01	01	H4709_029_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	029	0	1	01	01	H4709_029_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				673.40	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	029	0	1	01	01	H4709_029_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	029	0	1	01	01	H4709_029_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4709	031	0	1	01	01	H4709_031_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	031	0	1	01	01	H4709_031_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	031	0	1	01	01	H4709_031_0	5	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				9.82	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	031	0	1	01	01	H4709_031_0	5	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				105.39	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	031	0	1	01	01	H4709_031_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				66.17	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	031	0	1	01	01	H4709_031_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				658.07	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	031	0	1	01	01	H4709_031_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	031	0	1	01	01	H4709_031_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4709	032	0	1	01	01	H4709_032_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	032	0	1	01	01	H4709_032_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	032	0	1	01	01	H4709_032_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	5		15																					10																5				5		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	032	0	1	01	01	H4709_032_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	032	0	1	01	01	H4709_032_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	032	0	1	01	01	H4709_032_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				673.35	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	032	0	1	01	01	H4709_032_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	032	0	1	01	01	H4709_032_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4709	033	0	1	01	01	H4709_033_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	033	0	1	01	01	H4709_033_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	033	0	1	01	01	H4709_033_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	033	0	1	01	01	H4709_033_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	25		75																					50																25				25		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	033	0	1	01	01	H4709_033_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	033	0	1	01	01	H4709_033_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				405.73	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	033	0	1	01	01	H4709_033_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	033	0	1	01	01	H4709_033_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4709	035	0	1	01	01	H4709_035_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	035	0	1	01	01	H4709_035_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	035	0	1	01	01	H4709_035_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	035	0	1	01	01	H4709_035_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	25		75																					50																25				25		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	035	0	1	01	01	H4709_035_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	035	0	1	01	01	H4709_035_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				673.25	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	035	0	1	01	01	H4709_035_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	035	0	1	01	01	H4709_035_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4709	036	0	1	01	01	H4709_036_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	036	0	1	01	01	H4709_036_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	036	0	1	01	01	H4709_036_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	4		12																					8																4				4		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	036	0	1	01	01	H4709_036_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	036	0	1	01	01	H4709_036_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	036	0	1	01	01	H4709_036_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				673.28	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	036	0	1	01	01	H4709_036_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	036	0	1	01	01	H4709_036_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4709	037	0	1	01	01	H4709_037_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	037	0	1	01	01	H4709_037_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	037	0	1	01	01	H4709_037_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	037	0	1	01	01	H4709_037_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	037	0	1	01	01	H4709_037_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	90		270																					180																90				90		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	037	0	1	01	01	H4709_037_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				405.77	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	037	0	1	01	01	H4709_037_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	037	0	1	01	01	H4709_037_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4709	039	0	1	01	01	H4709_039_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	039	0	1	01	01	H4709_039_0	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	039	0	1	01	01	H4709_039_0	5	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				9.89	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	039	0	1	01	01	H4709_039_0	5	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				105.39	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	039	0	1	01	01	H4709_039_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				66.17	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	039	0	1	01	01	H4709_039_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				658.05	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	039	0	1	01	01	H4709_039_0	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	039	0	1	01	01	H4709_039_0	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4709	040	0	1	02	01	H4709_040_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H4709	040	0	1	02	01	H4709_040_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4709	040	0	1	02	01	H4709_040_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H4709	040	0	1	02	01	H4709_040_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H4709	040	0	1	02	01	H4709_040_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				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												
H4709	040	0	1	02	01	H4709_040_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				786.40	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	040	0	1	02	01	H4709_040_0	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	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, Select Care Drugs												
H4709	040	0	1	02	01	H4709_040_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4711	001	0	1	02	01	H4711_001_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	001	0	1	02	01	H4711_001_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H4711_001_0	2	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					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												
H4711	001	0	1	02	01	H4711_001_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H4711_001_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	001	0	1	02	01	H4711_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	001	0	1	02	01	H4711_001_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											955.51	33						452.59	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	002	0	1	02	01	H4711_002_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	002	0	1	02	01	H4711_002_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H4711_002_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	002	0	1	02	01	H4711_002_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H4711_002_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	002	0	1	02	01	H4711_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	002	0	1	02	01	H4711_002_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1064.60	33						438.85	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	005	0	1	02	01	H4711_005_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	005	0	1	02	01	H4711_005_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H4711_005_0	2	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					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												
H4711	005	0	1	02	01	H4711_005_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H4711_005_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	005	0	1	02	01	H4711_005_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	005	0	1	02	01	H4711_005_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1093.86	33						521.63	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	006	0	1	02	01	H4711_006_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	006	0	1	02	01	H4711_006_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H4711_006_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	006	0	1	02	01	H4711_006_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H4711_006_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	006	0	1	02	01	H4711_006_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	006	0	1	02	01	H4711_006_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											904.54	33						426.95	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	007	0	1	02	01	H4711_007_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	007	0	1	02	01	H4711_007_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H4711_007_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	007	0	1	02	01	H4711_007_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H4711_007_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	007	0	1	02	01	H4711_007_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	007	0	1	02	01	H4711_007_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1069.14	33						524.62	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	008	0	1	02	01	H4711_008_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	008	0	1	02	01	H4711_008_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H4711_008_0	2	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					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												
H4711	008	0	1	02	01	H4711_008_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H4711_008_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	008	0	1	02	01	H4711_008_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	008	0	1	02	01	H4711_008_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											967.77	33						410.82	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	009	0	1	02	01	H4711_009_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	009	0	1	02	01	H4711_009_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H4711_009_0	2	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					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												
H4711	009	0	1	02	01	H4711_009_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H4711_009_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	009	0	1	02	01	H4711_009_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	009	0	1	02	01	H4711_009_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											967.77	33						410.82	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	011	0	1	01	01	H4711_011_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H4711	011	0	1	01	01	H4711_011_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H4711	011	0	1	01	01	H4711_011_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	011	0	1	01	01	H4711_011_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											50.77	30	30	30				47.50	30	30	30										30	30	30				30	30	30				30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	011	0	1	01	01	H4711_011_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											571.18	25						367.03	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	012	0	1	01	01	H4711_012_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H4711	012	0	1	01	01	H4711_012_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H4711	012	0	1	01	01	H4711_012_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	012	0	1	01	01	H4711_012_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											42.31	25	25	25				39.56	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	012	0	1	01	01	H4711_012_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											568.72	25						365.86	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	013	0	1	01	01	H4711_013_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H4711	013	0	1	01	01	H4711_013_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H4711	013	0	1	01	01	H4711_013_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	013	0	1	01	01	H4711_013_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											42.81	25	25	25				40.02	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	013	0	1	01	01	H4711_013_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											574.76	25						369.97	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4739	001	0	1	01	01	H4739_001_0	4	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												
H4739	001	0	1	01	01	H4739_001_0	4	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												
H4754	004	0	1	04	01	H4754_004_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											96.79	33	33	33				87.70	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											88.99	33						61.64	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	4	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4754	007	0	1	04	01	H4754_007_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											92.92	32	32	32				82.82	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	007	0	1	04	01	H4754_007_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											128.33	30						85.36	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	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	4	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											96.61	31	31	31				85.76	30	30	30										31	31	31				30	30	30			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											121.84	28						88.15	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	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	4	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4754	011	0	1	04	01	H4754_011_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.52	30	30	30				95.33	29	29	29										30	30	30				29	29	29			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.87	30						113.29	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	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	4	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				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	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	017	0	1	04	01	H4754_017_0	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	017	0	1	04	01	H4754_017_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.71	32	32	32				89.08	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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											123.02	29						88.10	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	6	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	017	0	1	04	01	H4754_017_0	6	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4801	001	0	1	04	01	H4801_001_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	001	0	1	04	01	H4801_001_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H4801	001	0	1	04	01	H4801_001_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	001	0	1	04	01	H4801_001_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H4801	001	0	1	04	01	H4801_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	001	0	1	04	01	H4801_001_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												
H4801	002	0	1	04	01	H4801_002_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	002	0	1	04	01	H4801_002_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H4801	002	0	1	04	01	H4801_002_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	002	0	1	04	01	H4801_002_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H4801	002	0	1	04	01	H4801_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	002	0	1	04	01	H4801_002_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												
H4801	003	0	1	04	01	H4801_003_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	003	0	1	04	01	H4801_003_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H4801	003	0	1	04	01	H4801_003_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	003	0	1	04	01	H4801_003_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H4801	003	0	1	04	01	H4801_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	003	0	1	04	01	H4801_003_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	004	0	1	04	01	H4801_004_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	004	0	1	04	01	H4801_004_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H4801	004	0	1	04	01	H4801_004_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	004	0	1	04	01	H4801_004_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H4801	004	0	1	04	01	H4801_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	004	0	1	04	01	H4801_004_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	005	0	1	04	01	H4801_005_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	005	0	1	04	01	H4801_005_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H4801	005	0	1	04	01	H4801_005_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	005	0	1	04	01	H4801_005_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H4801	005	0	1	04	01	H4801_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	005	0	1	04	01	H4801_005_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	006	0	1	04	01	H4801_006_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	006	0	1	04	01	H4801_006_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H4801	006	0	1	04	01	H4801_006_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	006	0	1	04	01	H4801_006_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H4801	006	0	1	04	01	H4801_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	006	0	1	04	01	H4801_006_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	007	0	1	04	01	H4801_007_0	5	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	007	0	1	04	01	H4801_007_0	5	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H4801	007	0	1	04	01	H4801_007_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	007	0	1	04	01	H4801_007_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H4801	007	0	1	04	01	H4801_007_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	007	0	1	04	01	H4801_007_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	008	0	1	04	01	H4801_008_0	5	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	008	0	1	04	01	H4801_008_0	5	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H4801	008	0	1	04	01	H4801_008_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	008	0	1	04	01	H4801_008_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H4801	008	0	1	04	01	H4801_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	008	0	1	04	01	H4801_008_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	009	0	1	04	01	H4801_009_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	009	0	1	04	01	H4801_009_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H4801	009	0	1	04	01	H4801_009_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	009	0	1	04	01	H4801_009_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H4801	009	0	1	04	01	H4801_009_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	009	0	1	04	01	H4801_009_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												
H4801	010	0	1	04	01	H4801_010_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	010	0	1	04	01	H4801_010_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H4801	010	0	1	04	01	H4801_010_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	010	0	1	04	01	H4801_010_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H4801	010	0	1	04	01	H4801_010_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	010	0	1	04	01	H4801_010_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												
H4801	011	0	1	04	01	H4801_011_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	011	0	1	04	01	H4801_011_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H4801	011	0	1	04	01	H4801_011_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	011	0	1	04	01	H4801_011_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H4801	011	0	1	04	01	H4801_011_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	011	0	1	04	01	H4801_011_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	012	0	1	04	01	H4801_012_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	012	0	1	04	01	H4801_012_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H4801	012	0	1	04	01	H4801_012_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	012	0	1	04	01	H4801_012_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				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												
H4801	012	0	1	04	01	H4801_012_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	012	0	1	04	01	H4801_012_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												
H4801	013	0	1	04	01	H4801_013_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	013	0	1	04	01	H4801_013_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		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												
H4801	013	0	1	04	01	H4801_013_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					44.00		132.00											47.00		141.00				44.00		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												
H4801	013	0	1	04	01	H4801_013_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											64.96	30		30				51.36	25		25										30		30				25		25			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	013	0	1	04	01	H4801_013_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	014	0	1	04	01	H4801_014_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	014	0	1	04	01	H4801_014_0	3	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		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												
H4801	014	0	1	04	01	H4801_014_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					44.00		132.00											47.00		141.00				44.00		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												
H4801	014	0	1	04	01	H4801_014_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											84.02	38		38				68.40	33		33										38		38				33		33			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	014	0	1	04	01	H4801_014_0	3	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31												25							25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	002	0	1	04	01	H4829_002_0	3	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												
H4829	002	0	1	04	01	H4829_002_0	3	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		
H4829	002	0	1	04	01	H4829_002_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	002	0	1	04	01	H4829_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	002	0	1	04	01	H4829_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				526.00	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	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												
H4829	003	0	1	04	01	H4829_003_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H4829	003	0	1	04	01	H4829_003_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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												
H4829	003	0	1	04	01	H4829_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	003	0	1	04	01	H4829_003_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				381.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	004	0	1	04	01	H4829_004_0	3	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												
H4829	004	0	1	04	01	H4829_004_0	3	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		
H4829	004	0	1	04	01	H4829_004_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	004	0	1	04	01	H4829_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	004	0	1	04	01	H4829_004_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				533.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	005	0	1	04	01	H4829_005_0	4	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												
H4829	005	0	1	04	01	H4829_005_0	4	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		
H4829	005	0	1	04	01	H4829_005_0	4	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												
H4829	005	0	1	04	01	H4829_005_0	4	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
H4829	005	0	1	04	01	H4829_005_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	005	0	1	04	01	H4829_005_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	005	0	1	04	01	H4829_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				392.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	006	0	1	04	01	H4829_006_0	3	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												
H4829	006	0	1	04	01	H4829_006_0	3	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		
H4829	006	0	1	04	01	H4829_006_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	006	0	1	04	01	H4829_006_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	006	0	1	04	01	H4829_006_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	006	0	1	04	01	H4829_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	006	0	1	04	01	H4829_006_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				558.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	007	0	1	04	01	H4829_007_0	3	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												
H4829	007	0	1	04	01	H4829_007_0	3	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		
H4829	007	0	1	04	01	H4829_007_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	007	0	1	04	01	H4829_007_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	007	0	1	04	01	H4829_007_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	007	0	1	04	01	H4829_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	007	0	1	04	01	H4829_007_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				558.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	008	0	1	04	01	H4829_008_0	3	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												
H4829	008	0	1	04	01	H4829_008_0	3	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		
H4829	008	0	1	04	01	H4829_008_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	008	0	1	04	01	H4829_008_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	008	0	1	04	01	H4829_008_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	008	0	1	04	01	H4829_008_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	008	0	1	04	01	H4829_008_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				558.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	001	0	1	02	01	H4835_001_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	001	0	1	02	01	H4835_001_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H4835_001_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	001	0	1	02	01	H4835_001_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H4835_001_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	001	0	1	02	01	H4835_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	001	0	1	02	01	H4835_001_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											873.30	33						476.12	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	002	0	1	02	01	H4835_002_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	002	0	1	02	01	H4835_002_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H4835_002_0	2	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					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												
H4835	002	0	1	02	01	H4835_002_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H4835_002_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	002	0	1	02	01	H4835_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	002	0	1	02	01	H4835_002_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1220.77	33						446.25	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	003	0	1	02	01	H4835_003_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	003	0	1	02	01	H4835_003_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H4835_003_0	2	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					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												
H4835	003	0	1	02	01	H4835_003_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H4835_003_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	003	0	1	02	01	H4835_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	003	0	1	02	01	H4835_003_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1078.47	33						474.25	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	004	0	1	02	01	H4835_004_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	004	0	1	02	01	H4835_004_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H4835_004_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	004	0	1	02	01	H4835_004_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H4835_004_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	004	0	1	02	01	H4835_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	004	0	1	02	01	H4835_004_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1065.38	33						480.40	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	005	0	1	02	01	H4835_005_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	005	0	1	02	01	H4835_005_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H4835_005_0	2	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					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												
H4835	005	0	1	02	01	H4835_005_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	005	0	1	02	01	H4835_005_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	005	0	1	02	01	H4835_005_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	005	0	1	02	01	H4835_005_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1063.51	33						463.57	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	006	0	1	02	01	H4835_006_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	006	0	1	02	01	H4835_006_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H4835_006_0	3	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					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												
H4835	006	0	1	02	01	H4835_006_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H4835_006_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	006	0	1	02	01	H4835_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	006	0	1	02	01	H4835_006_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											906.65	28						448.53	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	001	0	1	01	01	H4847_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	001	0	1	01	01	H4847_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H4847	001	0	1	01	01	H4847_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H4847	001	0	1	01	01	H4847_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	240.00											90.00	180.00	270.00				80.00	160.00	160.00				90.00				90.00			3.00	2.67		3.00	2.67	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	001	0	1	01	01	H4847_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	001	0	1	01	01	H4847_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	001	0	1	01	01	H4847_001_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H4847	002	0	1	01	01	H4847_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	002	0	1	01	01	H4847_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H4847	002	0	1	01	01	H4847_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H4847	002	0	1	01	01	H4847_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	240.00											90.00	180.00	270.00				80.00	160.00	160.00				90.00				90.00			3.00	2.67		3.00	2.67	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	002	0	1	01	01	H4847_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	002	0	1	01	01	H4847_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	002	0	1	01	01	H4847_002_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H4847	004	0	1	01	01	H4847_004_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	004	0	1	01	01	H4847_004_0	4	Generic	4	11	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	12.00	0.00				6.00				6.00		0.2				0.2	0.2	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	004	0	1	01	01	H4847_004_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	43.00	86.00	129.00																									43.00	86.00	129.00				43.00	86.00	86.00				43.00				43.00		1.43				1.43	1.43	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	004	0	1	01	01	H4847_004_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				93.50	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	004	0	1	01	01	H4847_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	004	0	1	01	01	H4847_004_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	005	0	1	01	01	H4847_005_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	005	0	1	01	01	H4847_005_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	005	0	1	01	01	H4847_005_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H4847	005	0	1	01	01	H4847_005_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				95.85	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	005	0	1	01	01	H4847_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4847	005	0	1	01	01	H4847_005_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		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	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4853	001	0	1	01	01	H4853_001_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	5		15																					10																5				5		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	001	0	1	01	01	H4853_001_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		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	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				897.74	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	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4853	002	0	1	01	01	H4853_002_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4853	002	0	1	01	01	H4853_002_0	6	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				8.35	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	6	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				96.00	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	6	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				61.18	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				637.84	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	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4853	016	0	1	01	01	H4853_016_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	016	0	1	01	01	H4853_016_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4853	016	0	1	01	01	H4853_016_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	9		27																					18																9				9		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	016	0	1	01	01	H4853_016_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	016	0	1	01	01	H4853_016_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	90		270																					180																90				90		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	016	0	1	01	01	H4853_016_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				436.75	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	016	0	1	01	01	H4853_016_0	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	016	0	1	01	01	H4853_016_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4853	017	0	1	01	01	H4853_017_0	7	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	017	0	1	01	01	H4853_017_0	7	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4853	017	0	1	01	01	H4853_017_0	7	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				10.15	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	017	0	1	01	01	H4853_017_0	7	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				106.77	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	017	0	1	01	01	H4853_017_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				68.29	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	017	0	1	01	01	H4853_017_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				660.51	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	017	0	1	01	01	H4853_017_0	7	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	017	0	1	01	01	H4853_017_0	7	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4853	018	0	1	01	01	H4853_018_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	018	0	1	01	01	H4853_018_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4853	018	0	1	01	01	H4853_018_0	6	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				7.79	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	018	0	1	01	01	H4853_018_0	6	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				93.81	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	018	0	1	01	01	H4853_018_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				48.65	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	018	0	1	01	01	H4853_018_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				572.83	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	018	0	1	01	01	H4853_018_0	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	018	0	1	01	01	H4853_018_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4853	020	0	1	01	01	H4853_020_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	020	0	1	01	01	H4853_020_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H4853	020	0	1	01	01	H4853_020_0	6	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				10.15	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	020	0	1	01	01	H4853_020_0	6	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				106.77	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	020	0	1	01	01	H4853_020_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				68.29	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	020	0	1	01	01	H4853_020_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				660.52	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	020	0	1	01	01	H4853_020_0	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	020	0	1	01	01	H4853_020_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H4868	004	0	1	01	01	H4868_004_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	004	0	1	01	01	H4868_004_0	5	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	15.00				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												
H4868	004	0	1	01	01	H4868_004_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	004	0	1	01	01	H4868_004_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				94.39	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	004	0	1	01	01	H4868_004_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	004	0	1	01	01	H4868_004_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	014	0	1	01	01	H4868_014_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	014	0	1	01	01	H4868_014_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	014	0	1	01	01	H4868_014_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	014	0	1	01	01	H4868_014_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.57	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	014	0	1	01	01	H4868_014_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	014	0	1	01	01	H4868_014_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	016	0	1	01	01	H4868_016_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	016	0	1	01	01	H4868_016_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	016	0	1	01	01	H4868_016_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	016	0	1	01	01	H4868_016_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.91	45	45	45																								45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	016	0	1	01	01	H4868_016_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	016	0	1	01	01	H4868_016_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	019	0	1	01	01	H4868_019_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	019	0	1	01	01	H4868_019_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H4868	019	0	1	01	01	H4868_019_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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												
H4868	019	0	1	01	01	H4868_019_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.85	50	50	50				93.93	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	019	0	1	01	01	H4868_019_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	019	0	1	01	01	H4868_019_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4875	016	1	1	04	01	H4875_016_1	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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												
H4875	016	1	1	04	01	H4875_016_1	9	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	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												
H4875	016	1	1	04	01	H4875_016_1	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											42.47	50	50	50				57.65	50	50	50										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	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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												
H4875	016	2	1	04	01	H4875_016_2	9	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	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												
H4875	016	2	1	04	01	H4875_016_2	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											42.47	50	50	50				57.65	50	50	50										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	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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												
H4875	016	3	1	04	01	H4875_016_3	9	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	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												
H4875	016	3	1	04	01	H4875_016_3	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											42.47	50	50	50				57.65	50	50	50										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	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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												
H4875	016	4	1	04	01	H4875_016_4	9	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	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												
H4875	016	4	1	04	01	H4875_016_4	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											42.47	50	50	50				57.65	50	50	50										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	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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												
H4875	016	5	1	04	01	H4875_016_5	9	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	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												
H4875	016	5	1	04	01	H4875_016_5	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											42.47	50	50	50				57.65	50	50	50										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	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	9	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	36.00				7.00	14.00	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												
H4875	017	1	1	04	01	H4875_017_1	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	92.50				42.00				42.00			1.40	1.23		1.40	1.23	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.95	50	50	50				51.93	45	45	45										50	50	50				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	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	9	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	36.00				7.00	14.00	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												
H4875	017	2	1	04	01	H4875_017_2	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	92.50				42.00				42.00			1.40	1.23		1.40	1.23	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.95	50	50	50				51.93	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	9	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	36.00				7.00	14.00	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												
H4875	017	3	1	04	01	H4875_017_3	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	92.50				42.00				42.00			1.40	1.23		1.40	1.23	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.95	50	50	50				51.93	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	9	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	36.00				7.00	14.00	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												
H4875	017	4	1	04	01	H4875_017_4	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	92.50				42.00				42.00			1.40	1.23		1.40	1.23	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.95	50	50	50				51.93	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	9	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	36.00				7.00	14.00	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												
H4875	017	5	1	04	01	H4875_017_5	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	92.50				42.00				42.00			1.40	1.23		1.40	1.23	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.95	50	50	50				51.93	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	1	1	04	01	H4875_018_1	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											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												
H4875	018	1	1	04	01	H4875_018_1	9	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											18.00	36.00	54.00				13.00	26.00	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												
H4875	018	1	1	04	01	H4875_018_1	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	1	1	04	01	H4875_018_1	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.70	50	50	50				71.79	50	50	50										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	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			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	2	1	04	01	H4875_018_2	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											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												
H4875	018	2	1	04	01	H4875_018_2	9	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											18.00	36.00	54.00				13.00	26.00	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												
H4875	018	2	1	04	01	H4875_018_2	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	2	1	04	01	H4875_018_2	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.70	50	50	50				71.79	50	50	50										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	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			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	3	1	04	01	H4875_018_3	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											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												
H4875	018	3	1	04	01	H4875_018_3	9	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											18.00	36.00	54.00				13.00	26.00	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												
H4875	018	3	1	04	01	H4875_018_3	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	3	1	04	01	H4875_018_3	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.70	50	50	50				71.79	50	50	50										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	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			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	4	1	04	01	H4875_018_4	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											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												
H4875	018	4	1	04	01	H4875_018_4	9	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											18.00	36.00	54.00				13.00	26.00	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												
H4875	018	4	1	04	01	H4875_018_4	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	4	1	04	01	H4875_018_4	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.70	50	50	50				71.79	50	50	50										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	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			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	5	1	04	01	H4875_018_5	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											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												
H4875	018	5	1	04	01	H4875_018_5	9	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											18.00	36.00	54.00				13.00	26.00	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												
H4875	018	5	1	04	01	H4875_018_5	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	5	1	04	01	H4875_018_5	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.70	50	50	50				71.79	50	50	50										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	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			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	1	1	04	01	H4875_020_1	10	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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												
H4875	020	1	1	04	01	H4875_020_1	10	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	24.00											13.00	26.00	39.00				8.00	16.00	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												
H4875	020	1	1	04	01	H4875_020_1	10	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											43.00	86.00	129.00				38.00	76.00	95.00				43.00				43.00			1.43	1.27		1.43	1.27	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	1	1	04	01	H4875_020_1	10	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.87	45	45	45				36.42	40	40	40										45	45	45				40	40	40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	1	1	04	01	H4875_020_1	10	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	2	1	04	01	H4875_020_2	10	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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												
H4875	020	2	1	04	01	H4875_020_2	10	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	24.00											13.00	26.00	39.00				8.00	16.00	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												
H4875	020	2	1	04	01	H4875_020_2	10	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											43.00	86.00	129.00				38.00	76.00	95.00				43.00				43.00			1.43	1.27		1.43	1.27	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	2	1	04	01	H4875_020_2	10	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.87	45	45	45				36.42	40	40	40										45	45	45				40	40	40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	2	1	04	01	H4875_020_2	10	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	3	1	04	01	H4875_020_3	10	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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												
H4875	020	3	1	04	01	H4875_020_3	10	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	24.00											13.00	26.00	39.00				8.00	16.00	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												
H4875	020	3	1	04	01	H4875_020_3	10	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											43.00	86.00	129.00				38.00	76.00	95.00				43.00				43.00			1.43	1.27		1.43	1.27	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	3	1	04	01	H4875_020_3	10	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.87	45	45	45				36.42	40	40	40										45	45	45				40	40	40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	3	1	04	01	H4875_020_3	10	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	1	1	04	01	H4875_021_1	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	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												
H4875	021	1	1	04	01	H4875_021_1	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	1	1	04	01	H4875_021_1	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	1	1	04	01	H4875_021_1	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.78	50	50	50				44.03	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	1	1	04	01	H4875_021_1	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	2	1	04	01	H4875_021_2	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	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												
H4875	021	2	1	04	01	H4875_021_2	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	2	1	04	01	H4875_021_2	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	2	1	04	01	H4875_021_2	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.78	50	50	50				44.03	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	2	1	04	01	H4875_021_2	9	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			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	1	1	04	01	H4875_022_1	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	1	1	04	01	H4875_022_1	9	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	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												
H4875	022	1	1	04	01	H4875_022_1	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	1	1	04	01	H4875_022_1	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.36	50	50	50				74.05	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	1	1	04	01	H4875_022_1	9	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			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	2	1	04	01	H4875_022_2	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	2	1	04	01	H4875_022_2	9	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	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												
H4875	022	2	1	04	01	H4875_022_2	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	2	1	04	01	H4875_022_2	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.36	50	50	50				74.05	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	2	1	04	01	H4875_022_2	9	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			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	5	1	04	01	H4875_022_5	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	5	1	04	01	H4875_022_5	9	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	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												
H4875	022	5	1	04	01	H4875_022_5	9	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	5	1	04	01	H4875_022_5	9	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.36	50	50	50				74.05	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	5	1	04	01	H4875_022_5	9	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			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	001	0	1	04	01	H4882_001_0	7	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	001	0	1	04	01	H4882_001_0	7	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	Preferred Brand	4	11	1	2	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	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				67.18	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				808.33	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	002	0	1	04	01	H4882_002_0	6	Preferred Generic	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												
H4882	002	0	1	04	01	H4882_002_0	6	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		28.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	002	0	1	04	01	H4882_002_0	6	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		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	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				71.10	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				612.04	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	003	0	1	04	01	H4882_003_0	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		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	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				76.76	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	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				694.58	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	004	0	1	04	01	H4882_004_0	5	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	004	0	1	04	01	H4882_004_0	5	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	5	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									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	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				573.37	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	005	0	1	04	01	H4882_005_0	5	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	5	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	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									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	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				674.19	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	006	0	1	04	01	H4882_006_0	5	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	006	0	1	04	01	H4882_006_0	5	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									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	5	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		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	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				57.56	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	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				578.68	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	007	0	1	04	01	H4882_007_0	6	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	007	0	1	04	01	H4882_007_0	6	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		28.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	007	0	1	04	01	H4882_007_0	6	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		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	007	0	1	04	01	H4882_007_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				71.10	35		35																								35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	007	0	1	04	01	H4882_007_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				612.04	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	008	0	1	04	01	H4882_008_0	6	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	008	0	1	04	01	H4882_008_0	6	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	008	0	1	04	01	H4882_008_0	6	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		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	008	0	1	04	01	H4882_008_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				57.56	40		40																								40		40				40		40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	008	0	1	04	01	H4882_008_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				578.68	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	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	014	0	1	04	01	H4909_014_0	6	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					0.00	0.00	0.00																18.00				18.00			0.60	0.43	0.00			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	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	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	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	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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	7	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					0.00	0.00	0.00																18.00				18.00			0.60	0.43	0.00			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	015	0	1	04	01	H4909_015_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	015	0	1	04	01	H4909_015_0	7	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	7	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	8	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	8	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					0.00	0.00	0.00																18.00				18.00			0.60	0.43	0.00			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	016	0	1	04	01	H4909_016_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	016	0	1	04	01	H4909_016_0	8	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	8	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					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												
H4909	018	0	1	04	01	H4909_018_0	6	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												
H4909	018	0	1	04	01	H4909_018_0	6	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	120.00					40.00	120.00	120.00																40.00				40.00			1.33	1.33	1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	018	0	1	04	01	H4909_018_0	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	018	0	1	04	01	H4909_018_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				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												
H4909	022	0	1	04	01	H4909_022_0	12	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					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, Select Care Drugs												
H4909	022	0	1	04	01	H4909_022_0	12	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	022	0	1	04	01	H4909_022_0	12	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												
H4909	022	0	1	04	01	H4909_022_0	12	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												
H4909	022	0	1	04	01	H4909_022_0	12	Specialty Tier	4	11	1	1	5	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	022	0	1	04	01	H4909_022_0	12	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	022	0	1	04	01	H4909_022_0	12	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	024	0	1	04	01	H4909_024_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	024	0	1	04	01	H4909_024_0	7	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	024	0	1	04	01	H4909_024_0	7	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	024	0	1	04	01	H4909_024_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	024	0	1	04	01	H4909_024_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	024	0	1	04	01	H4909_024_0	7	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	024	0	1	04	01	H4909_024_0	7	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	025	0	1	04	01	H4909_025_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	025	0	1	04	01	H4909_025_0	7	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	025	0	1	04	01	H4909_025_0	7	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	025	0	1	04	01	H4909_025_0	7	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	025	0	1	04	01	H4909_025_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	025	0	1	04	01	H4909_025_0	7	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	025	0	1	04	01	H4909_025_0	7	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	026	0	1	04	01	H4909_026_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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	026	0	1	04	01	H4909_026_0	6	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					0.00	0.00	0.00																18.00				18.00			0.60	0.43	0.00			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	026	0	1	04	01	H4909_026_0	6	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	026	0	1	04	01	H4909_026_0	6	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	026	0	1	04	01	H4909_026_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	026	0	1	04	01	H4909_026_0	6	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	026	0	1	04	01	H4909_026_0	6	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				100.00	27	27	27																				27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4931	001	0	1	01	01	H4931_001_0	11	Preferred Generic	4	01	1	1	1	1	110		01	100		1	31		90				1	2			90				31		31				2.34	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	001	0	1	01	01	H4931_001_0	11	Generic	4	01	1	1	2	1	110		01	100		1	31		90				1	2			90				31		31				4.39	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	001	0	1	01	01	H4931_001_0	11	Preferred Brand	4	10	1	1	3	1	110		01	100		1	31		90				1	2			90				31		31				65.33	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	001	0	1	01	01	H4931_001_0	11	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				52.46	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	001	0	1	01	01	H4931_001_0	11	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				621.91	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	001	0	1	01	01	H4931_001_0	11	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	31		100				1	2			100				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, Select Care Drugs												
H4931	001	0	1	01	01	H4931_001_0	11	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	31		100				1	2			100				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, Select Care Drugs										1		
H4931	006	0	1	01	01	H4931_006_0	13	Preferred Generic	4	01	1	1	1	1	110		01	100		1	31		90				1	2			90				31		31				2.44	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	006	0	1	01	01	H4931_006_0	13	Generic	4	01	1	1	2	1	110		01	100		1	31		90				1	2			90				31		31				4.54	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	006	0	1	01	01	H4931_006_0	13	Preferred Brand	4	10	1	1	3	1	110		01	100		1	31		90				1	2			90				31		31				63.15	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	006	0	1	01	01	H4931_006_0	13	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				44.59	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	006	0	1	01	01	H4931_006_0	13	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				539.57	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	006	0	1	01	01	H4931_006_0	13	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	31		100				1	2			100				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, Select Care Drugs												
H4931	006	0	1	01	01	H4931_006_0	13	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	31		100				1	2			100				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, Select Care Drugs										1		
H4931	007	0	1	01	01	H4931_007_0	12	Preferred Generic	4	01	1	1	1	1	110		01	100		1	31		90				1	2			90				31		31				2.33	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	007	0	1	01	01	H4931_007_0	12	Generic	4	01	1	1	2	1	110		01	100		1	31		90				1	2			90				31		31				4.29	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	007	0	1	01	01	H4931_007_0	12	Preferred Brand	4	10	1	1	3	1	110		01	100		1	31		90				1	2			90				31		31				63.98	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	007	0	1	01	01	H4931_007_0	12	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				43.07	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	007	0	1	01	01	H4931_007_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				551.43	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	007	0	1	01	01	H4931_007_0	12	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	31		100				1	2			100				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, Select Care Drugs												
H4931	007	0	1	01	01	H4931_007_0	12	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	31		100				1	2			100				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, Select Care Drugs										1		
H4931	008	0	1	01	01	H4931_008_0	12	Preferred Generic	4	01	1	1	1	1	110		01	100		1	31		90				1	2			90				31		31				2.18	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	008	0	1	01	01	H4931_008_0	12	Generic	4	01	1	1	2	1	110		01	100		1	31		90				1	2			90				31		31				3.84	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	008	0	1	01	01	H4931_008_0	12	Preferred Brand	4	10	1	1	3	1	110		01	100		1	31		90				1	2			90				31		31				73.21	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	008	0	1	01	01	H4931_008_0	12	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				53.21	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	008	0	1	01	01	H4931_008_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				789.56	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	008	0	1	01	01	H4931_008_0	12	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	31		100				1	2			100				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, Select Care Drugs												
H4931	008	0	1	01	01	H4931_008_0	12	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	31		100				1	2			100				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, Select Care Drugs										1		
H4931	013	0	1	01	01	H4931_013_0	12	Preferred Generic	4	01	1	1	1	1	110		01	100		1	31		90				1	2			90				31		31				2.70	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	013	0	1	01	01	H4931_013_0	12	Generic	4	01	1	1	2	1	110		01	100		1	31		90				1	2			90				31		31				5.14	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	013	0	1	01	01	H4931_013_0	12	Preferred Brand	4	10	1	1	3	1	110		01	100		1	31		90				1	2			90				31		31				60.54	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	013	0	1	01	01	H4931_013_0	12	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				39.74	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	013	0	1	01	01	H4931_013_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				543.76	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	013	0	1	01	01	H4931_013_0	12	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	31		100				1	2			100				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, Select Care Drugs												
H4931	013	0	1	01	01	H4931_013_0	12	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	31		100				1	2			100				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, Select Care Drugs										1		
H4931	014	0	1	01	01	H4931_014_0	12	Preferred Generic	4	01	1	1	1	1	110		01	100		1	31		90				1	2			90				31		31				2.82	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	014	0	1	01	01	H4931_014_0	12	Generic	4	01	1	1	2	1	110		01	100		1	31		90				1	2			90				31		31				5.70	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	014	0	1	01	01	H4931_014_0	12	Preferred Brand	4	10	1	1	3	1	110		01	100		1	31		90				1	2			90				31		31				60.51	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	014	0	1	01	01	H4931_014_0	12	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				41.59	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	014	0	1	01	01	H4931_014_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				462.59	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	014	0	1	01	01	H4931_014_0	12	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	31		100				1	2			100				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, Select Care Drugs												
H4931	014	0	1	01	01	H4931_014_0	12	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	31		100				1	2			100				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, Select Care Drugs										1		
H4931	015	0	1	01	01	H4931_015_0	12	Preferred Generic	4	01	1	1	1	1	110		01	100		1	31		90				1	2			90				31		31				3.44	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	015	0	1	01	01	H4931_015_0	12	Generic	4	01	1	1	2	1	110		01	100		1	31		90				1	2			90				31		31				6.76	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	015	0	1	01	01	H4931_015_0	12	Preferred Brand	4	10	1	1	3	1	110		01	100		1	31		90				1	2			90				31		31				61.84	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	015	0	1	01	01	H4931_015_0	12	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				42.60	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	015	0	1	01	01	H4931_015_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				485.11	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	015	0	1	01	01	H4931_015_0	12	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	31		100				1	2			100				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, Select Care Drugs												
H4931	015	0	1	01	01	H4931_015_0	12	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	31		100				1	2			100				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, Select Care Drugs										1		
H4931	016	0	1	01	01	H4931_016_0	12	Preferred Generic	4	01	1	1	1	1	110		01	100		1	31		90				1	2			90				31		31				2.70	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	016	0	1	01	01	H4931_016_0	12	Generic	4	01	1	1	2	1	110		01	100		1	31		90				1	2			90				31		31				4.92	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	016	0	1	01	01	H4931_016_0	12	Preferred Brand	4	10	1	1	3	1	110		01	100		1	31		90				1	2			90				31		31				65.75	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	016	0	1	01	01	H4931_016_0	12	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				56.99	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	016	0	1	01	01	H4931_016_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				546.65	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4931	016	0	1	01	01	H4931_016_0	12	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	31		100				1	2			100				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, Select Care Drugs												
H4931	016	0	1	01	01	H4931_016_0	12	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	31		100				1	2			100				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, Select Care Drugs										1		
H4937	001	0	1	04	01	H4937_001_0	7	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											941.73	25						941.73	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4961	001	0	1	04	01	H4961_001_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	001	0	1	04	01	H4961_001_0	7	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	15.00																			5.00	10.00	15.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	001	0	1	04	01	H4961_001_0	7	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	001	0	1	04	01	H4961_001_0	7	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			100.00		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	7	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1078.00	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	7	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			5.00		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	7	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			5.00		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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	003	0	1	04	01	H4961_003_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	15.00																			5.00	10.00	15.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	003	0	1	04	01	H4961_003_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	003	0	1	04	01	H4961_003_0	3	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			100.00		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	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1059.00	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	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			5.00		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	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			5.00		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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	006	0	1	04	01	H4961_006_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	3.00	6.00	9.00																			3.00	6.00	9.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	006	0	1	04	01	H4961_006_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	006	0	1	04	01	H4961_006_0	3	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	279.00																	93.00			93.00		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	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				995.00	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	3	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			3.00		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	3	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			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4961	007	0	1	04	01	H4961_007_0	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	007	0	1	04	01	H4961_007_0	9	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	15.00																			5.00	10.00	15.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	007	0	1	04	01	H4961_007_0	9	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	007	0	1	04	01	H4961_007_0	9	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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	007	0	1	04	01	H4961_007_0	9	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1007.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	007	0	1	04	01	H4961_007_0	9	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			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	007	0	1	04	01	H4961_007_0	9	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			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4961	008	0	1	04	01	H4961_008_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	008	0	1	04	01	H4961_008_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	15.00																			5.00	10.00	15.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	008	0	1	04	01	H4961_008_0	3	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	008	0	1	04	01	H4961_008_0	3	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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	008	0	1	04	01	H4961_008_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1006.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	008	0	1	04	01	H4961_008_0	3	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	008	0	1	04	01	H4961_008_0	3	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4982	001	0	1	01	01	H4982_001_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	001	0	1	01	01	H4982_001_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	001	0	1	01	01	H4982_001_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H4982	001	0	1	01	01	H4982_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H4982	001	0	1	01	01	H4982_001_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											981.42	33						405.63	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	002	0	1	01	01	H4982_002_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	002	0	1	01	01	H4982_002_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	002	0	1	01	01	H4982_002_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H4982	002	0	1	01	01	H4982_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H4982	002	0	1	01	01	H4982_002_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											734.05	33						328.24	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	003	0	1	01	01	H4982_003_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	003	0	1	01	01	H4982_003_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	003	0	1	01	01	H4982_003_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H4982	003	0	1	01	01	H4982_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H4982	003	0	1	01	01	H4982_003_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1146.78	33						532.33	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	004	0	1	01	01	H4982_004_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	004	0	1	01	01	H4982_004_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	004	0	1	01	01	H4982_004_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H4982	004	0	1	01	01	H4982_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H4982	004	0	1	01	01	H4982_004_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											939.78	33						394.65	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	005	0	1	01	01	H4982_005_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	005	0	1	01	01	H4982_005_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	005	0	1	01	01	H4982_005_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H4982	005	0	1	01	01	H4982_005_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H4982	005	0	1	01	01	H4982_005_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											870.95	33						410.38	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	006	0	1	01	01	H4982_006_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	006	0	1	01	01	H4982_006_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	006	0	1	01	01	H4982_006_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H4982	006	0	1	01	01	H4982_006_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H4982	006	0	1	01	01	H4982_006_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											866.83	33						412.04	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	007	0	1	01	01	H4982_007_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	007	0	1	01	01	H4982_007_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	007	0	1	01	01	H4982_007_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H4982	007	0	1	01	01	H4982_007_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H4982	007	0	1	01	01	H4982_007_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											859.09	33						429.09	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	008	0	1	01	01	H4982_008_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H4982	008	0	1	01	01	H4982_008_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H4982	008	0	1	01	01	H4982_008_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	008	0	1	01	01	H4982_008_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											43.87	25	25	25				41.05	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	008	0	1	01	01	H4982_008_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											587.63	25						377.45	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	009	0	1	01	01	H4982_009_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H4982	009	0	1	01	01	H4982_009_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H4982	009	0	1	01	01	H4982_009_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	009	0	1	01	01	H4982_009_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											43.78	25	25	25				40.96	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	009	0	1	01	01	H4982_009_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											587.40	25						377.21	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	010	0	1	01	01	H4982_010_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	010	0	1	01	01	H4982_010_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	010	0	1	01	01	H4982_010_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H4982	010	0	1	01	01	H4982_010_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H4982	010	0	1	01	01	H4982_010_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1086.03	33						460.93	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	011	0	1	01	01	H4982_011_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	011	0	1	01	01	H4982_011_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	011	0	1	01	01	H4982_011_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H4982	011	0	1	01	01	H4982_011_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H4982	011	0	1	01	01	H4982_011_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1086.03	33						460.93	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	012	0	1	01	01	H4982_012_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	012	0	1	01	01	H4982_012_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	012	0	1	01	01	H4982_012_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H4982	012	0	1	01	01	H4982_012_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H4982	012	0	1	01	01	H4982_012_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1104.17	33						456.09	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	015	0	1	01	01	H4982_015_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H4982	015	0	1	01	01	H4982_015_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H4982	015	0	1	01	01	H4982_015_0	3	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											30.87	25	25	25				37.67	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	015	0	1	01	01	H4982_015_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											65.06	35	35	35				57.60	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	015	0	1	01	01	H4982_015_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											687.76	29						441.45	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	7	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					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												
H5009	002	0	1	04	01	H5009_002_0	7	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					8.00	16.00	16.00					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												
H5009	002	0	1	04	01	H5009_002_0	7	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1011.47	28						1011.47	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	008	0	1	04	01	H5009_008_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					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												
H5009	008	0	1	04	01	H5009_008_0	8	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	8	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	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1011.47	28						1011.47	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	009	0	1	04	01	H5009_009_0	8	Preferred Generic	4	01	3	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					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												
H5009	009	0	1	04	01	H5009_009_0	8	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	60.00					13.00	26.00	39.00					13.00	26.00	0.00																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	8	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					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												
H5009	009	0	1	04	01	H5009_009_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											975.34	27						975.34	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	010	0	1	04	01	H5009_010_0	8	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	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												
H5009	010	0	1	04	01	H5009_010_0	8	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	60.00					13.00	26.00	39.00					13.00	26.00	0.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	010	0	1	04	01	H5009_010_0	8	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					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												
H5009	010	0	1	04	01	H5009_010_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	010	0	1	04	01	H5009_010_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											975.34	27						975.34	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	7	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					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												
H5010	002	0	1	04	01	H5010_002_0	7	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	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1047.59	29						1047.59	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	007	0	1	04	01	H5010_007_0	8	Preferred Generic	4	01	3	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					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												
H5010	007	0	1	04	01	H5010_007_0	8	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	60.00					13.00	26.00	39.00					13.00	26.00	0.00																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	8	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					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												
H5010	007	0	1	04	01	H5010_007_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											975.34	27						975.34	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	009	0	1	04	01	H5042_009_0	8	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	3.00	6.00	9.00																									3.00	6.00	9.00				0.00	0.00	0.00				3.00				3.00		0.10				0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	009	0	1	04	01	H5042_009_0	8	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	17.00	34.00	51.00																									17.00	34.00	51.00				17.00	34.00	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	8	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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												
H5042	009	0	1	04	01	H5042_009_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	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	8	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	7	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	2.00	4.00	6.00																									2.00	4.00	6.00				0.00	0.00	0.00				2.00				2.00		0.07				0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	011	0	1	04	01	H5042_011_0	7	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	14.00	28.00	42.00																									14.00	28.00	42.00				14.00	28.00	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	7	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																									44.00	88.00	132.00				44.00	88.00	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	7	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	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	7	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	7	Preferred Generic	4	11	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	7	Preferred Generic	4	11	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	009	0	1	01	01	H5050_009_0	7	Preferred Generic	4	11	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	7	Preferred Generic	4	11	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	013	0	1	01	01	H5050_013_0	7	Preferred Generic	4	11	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	7	Preferred Generic	4	11	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	7	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	7	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	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_0	7	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	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	017	0	1	01	01	H5050_017_0	7	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				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	7	Preferred Generic	4	11	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	7	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	7	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	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_0	7	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				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	7	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												
H5050	017	0	1	01	01	H5050_017_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	019	0	1	01	01	H5050_019_0	8	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	0.00	0.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	8	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	0.00	0.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	019	0	1	01	01	H5050_019_0	8	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	0.00	0.00																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	8	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	0.00	0.00																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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	8	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	021	0	1	01	01	H5050_021_0	7	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	0.00	0.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	7	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	0.00	0.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	021	0	1	01	01	H5050_021_0	7	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	0.00	0.00																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	7	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	0.00	0.00																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	7	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	7	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	7	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												
H5050	021	0	1	01	01	H5050_021_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	022	0	1	01	01	H5050_022_0	7	Preferred Generic	4	11	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	7	Preferred Generic	4	11	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	7	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	7	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	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	7	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	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	023	0	1	01	01	H5050_023_0	7	Preferred Generic	4	11	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	7	Preferred Generic	4	11	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	7	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	7	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	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	023	0	1	01	01	H5050_023_0	7	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	7	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, Vaccines												
H5050	023	0	1	01	01	H5050_023_0	7	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	023	0	1	01	01	H5050_023_0	7	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5087	001	0	1	01	01	H5087_001_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	001	0	1	01	01	H5087_001_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	001	0	1	01	01	H5087_001_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H5087	001	0	1	01	01	H5087_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.87	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	001	0	1	01	01	H5087_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	001	0	1	01	01	H5087_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	002	0	1	01	01	H5087_002_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	002	0	1	01	01	H5087_002_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	002	0	1	01	01	H5087_002_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H5087	002	0	1	01	01	H5087_002_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.01	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	002	0	1	01	01	H5087_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	002	0	1	01	01	H5087_002_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	005	0	1	01	01	H5087_005_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	005	0	1	01	01	H5087_005_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5087	005	0	1	01	01	H5087_005_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	005	0	1	01	01	H5087_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								25.00	50.00	75.00					15.00	30.00	45.00											25.00	50.00	75.00				15.00	30.00	30.00				25.00				25.00			0.83	0.5		0.83	0.5	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	005	0	1	01	01	H5087_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	297.00					89.00	178.00	267.00											99.00	198.00	297.00				89.00	178.00	178.00				99.00				99.00			3.3	2.97		3.3	2.97	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	005	0	1	01	01	H5087_005_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	005	0	1	01	01	H5087_005_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	005	0	1	01	01	H5087_005_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5087	016	0	1	01	01	H5087_016_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	016	0	1	01	01	H5087_016_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5087	016	0	1	01	01	H5087_016_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	016	0	1	01	01	H5087_016_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H5087	016	0	1	01	01	H5087_016_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	297.00					89.00	178.00	267.00											99.00	198.00	297.00				89.00	178.00	178.00				99.00				99.00			3.3	2.97		3.3	2.97	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	016	0	1	01	01	H5087_016_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	016	0	1	01	01	H5087_016_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	016	0	1	01	01	H5087_016_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5087	024	0	1	01	01	H5087_024_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	024	0	1	01	01	H5087_024_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5087	024	0	1	01	01	H5087_024_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	024	0	1	01	01	H5087_024_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H5087	024	0	1	01	01	H5087_024_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	297.00					89.00	178.00	267.00											99.00	198.00	297.00				89.00	178.00	178.00				99.00				99.00			3.3	2.97		3.3	2.97	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	024	0	1	01	01	H5087_024_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	024	0	1	01	01	H5087_024_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	024	0	1	01	01	H5087_024_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5087	025	0	1	01	01	H5087_025_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	025	0	1	01	01	H5087_025_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5087	025	0	1	01	01	H5087_025_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H5087	025	0	1	01	01	H5087_025_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H5087	025	0	1	01	01	H5087_025_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	297.00					89.00	178.00	267.00											99.00	198.00	297.00				89.00	178.00	178.00				99.00				99.00			3.3	2.97		3.3	2.97	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	025	0	1	01	01	H5087_025_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	025	0	1	01	01	H5087_025_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	025	0	1	01	01	H5087_025_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5087	026	0	1	01	01	H5087_026_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	026	0	1	01	01	H5087_026_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5087	026	0	1	01	01	H5087_026_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	026	0	1	01	01	H5087_026_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								25.00	50.00	75.00					15.00	30.00	45.00											25.00	50.00	75.00				15.00	30.00	30.00				25.00				25.00			0.83	0.5		0.83	0.5	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	026	0	1	01	01	H5087_026_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	297.00					89.00	178.00	267.00											99.00	198.00	297.00				89.00	178.00	178.00				99.00				99.00			3.3	2.97		3.3	2.97	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	026	0	1	01	01	H5087_026_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	026	0	1	01	01	H5087_026_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	026	0	1	01	01	H5087_026_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5087	027	0	1	01	01	H5087_027_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	027	0	1	01	01	H5087_027_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	12.00	24.00	36.00																									12.00	24.00	36.00				12.00	24.00	0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	027	0	1	01	01	H5087_027_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H5087	027	0	1	01	01	H5087_027_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				96.34	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	027	0	1	01	01	H5087_027_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	027	0	1	01	01	H5087_027_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	028	0	1	01	01	H5087_028_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5087	028	0	1	01	01	H5087_028_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2	2	3
H5087	028	0	1	01	01	H5087_028_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Diabetic Drugs												
H5087	028	0	1	01	01	H5087_028_0	5	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Diabetic Drugs										1		
H5087	028	0	1	01	01	H5087_028_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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 Diabetic Drugs												
H5087	028	0	1	01	01	H5087_028_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	297.00					89.00	178.00	267.00											99.00	198.00	297.00				89.00	178.00	178.00				99.00				99.00			3.3	2.97		3.3	2.97	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5087	028	0	1	01	01	H5087_028_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5087	028	0	1	01	01	H5087_028_0	5	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H5087	028	0	1	01	01	H5087_028_0	5	Select Diabetic Drugs	4	10	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 Diabetic Drugs										2		
H5106	013	0	1	04	01	H5106_013_0	6	Preferred Generic	4	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								5.00		15.00					0.00		0.00							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	6	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							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	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1161.17	33						1161.17	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	1	1	04	01	H5106_029_1	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					0.00		0.00							0.00																15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	1	1	04	01	H5106_029_1	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1100.45	33						1100.45	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	2	1	04	01	H5106_029_2	6	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							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	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					0.00		0.00							0.00																15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	2	1	04	01	H5106_029_2	6	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							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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1100.45	33						1100.45	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	1	1	04	01	H5106_030_1	6	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							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	1	1	04	01	H5106_030_1	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								20.00		60.00					7.00		21.00							0.00																20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	1	1	04	01	H5106_030_1	6	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							120.00																47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	1	1	04	01	H5106_030_1	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	030	1	1	04	01	H5106_030_1	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											974.51	33						974.51	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	2	1	04	01	H5106_030_2	6	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							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	2	1	04	01	H5106_030_2	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								20.00		60.00					7.00		21.00							0.00																20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	2	1	04	01	H5106_030_2	6	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							120.00																47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	2	1	04	01	H5106_030_2	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		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	030	2	1	04	01	H5106_030_2	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											974.51	33						974.51	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5117	003	0	1	01	01	H5117_003_0	3	Preferred Generic	4	11	3	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	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												
H5117	003	0	1	01	01	H5117_003_0	3	Preferred Generic	4	11	3	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	15.00				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		3
H5117	003	0	1	01	01	H5117_003_0	3	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	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	3	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	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, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	3	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		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	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										2	2	
H5117	004	0	1	01	01	H5117_004_0	3	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	004	0	1	01	01	H5117_004_0	3	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	9.00	18.00	27.00																									9.00	18.00	27.00				9.00	18.00	0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	004	0	1	01	01	H5117_004_0	3	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	004	0	1	01	01	H5117_004_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.05	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	004	0	1	01	01	H5117_004_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, Select Care Drugs												
H5117	004	0	1	01	01	H5117_004_0	3	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5126	001	0	1	01	01	H5126_001_0	7	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		90				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	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5126	001	0	1	01	01	H5126_001_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				893.50	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5126	003	0	1	01	01	H5126_003_0	6	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5126	003	0	1	01	01	H5126_003_0	6	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		1
H5126	003	0	1	01	01	H5126_003_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5126	003	0	1	01	01	H5126_003_0	6	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	003	0	1	01	01	H5126_003_0	6	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	003	0	1	01	01	H5126_003_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				632.02	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5140	001	0	1	04	01	H5140_001_0	11	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1305.42	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5140	002	0	1	04	01	H5140_002_0	11	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	11	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	11	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	11	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	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1378.84	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	17	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	17	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	17	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	17	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	17	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	16	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	16	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	16	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	16	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	16	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2378.34	30	30	30				2378.34	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	13	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	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	13	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	13	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	13	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	13	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	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	025	0	1	04	01	H5141_025_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	025	0	1	04	01	H5141_025_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	025	0	1	04	01	H5141_025_0	15	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	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	026	0	1	04	01	H5141_026_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	026	0	1	04	01	H5141_026_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	026	0	1	04	01	H5141_026_0	15	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											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	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	032	0	1	04	01	H5141_032_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					47.00	94.00	141.00							110.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	032	0	1	04	01	H5141_032_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	032	0	1	04	01	H5141_032_0	15	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	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	033	0	1	04	01	H5141_033_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	033	0	1	04	01	H5141_033_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	033	0	1	04	01	H5141_033_0	15	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	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	034	0	1	04	01	H5141_034_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	034	0	1	04	01	H5141_034_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	034	0	1	04	01	H5141_034_0	15	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											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	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	035	0	1	04	01	H5141_035_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	035	0	1	04	01	H5141_035_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	035	0	1	04	01	H5141_035_0	15	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	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	036	0	1	04	01	H5141_036_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	036	0	1	04	01	H5141_036_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	036	0	1	04	01	H5141_036_0	15	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	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	15	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	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	038	0	1	04	01	H5141_038_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	038	0	1	04	01	H5141_038_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	038	0	1	04	01	H5141_038_0	15	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	14	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	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	14	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	14	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	14	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	14	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	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	040	0	1	04	01	H5141_040_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	040	0	1	04	01	H5141_040_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	040	0	1	04	01	H5141_040_0	15	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	13	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	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	13	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	042	0	1	04	01	H5141_042_0	13	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	042	0	1	04	01	H5141_042_0	13	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	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	14	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	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	14	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	14	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	14	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	14	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	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	046	0	1	04	01	H5141_046_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	046	0	1	04	01	H5141_046_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	046	0	1	04	01	H5141_046_0	15	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	14	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	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	14	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	14	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	14	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	14	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	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	048	0	1	04	01	H5141_048_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	048	0	1	04	01	H5141_048_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	048	0	1	04	01	H5141_048_0	15	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	14	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	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	14	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	14	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	14	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	14	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	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	050	0	1	04	01	H5141_050_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	050	0	1	04	01	H5141_050_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	050	0	1	04	01	H5141_050_0	15	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	14	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	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	14	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	14	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	14	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	14	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	052	0	1	04	01	H5141_052_0	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	052	0	1	04	01	H5141_052_0	15	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	052	0	1	04	01	H5141_052_0	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	052	0	1	04	01	H5141_052_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	052	0	1	04	01	H5141_052_0	15	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	053	0	1	04	01	H5141_053_0	14	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	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	053	0	1	04	01	H5141_053_0	14	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	053	0	1	04	01	H5141_053_0	14	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	053	0	1	04	01	H5141_053_0	14	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	053	0	1	04	01	H5141_053_0	14	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	054	0	1	04	01	H5141_054_0	14	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	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	054	0	1	04	01	H5141_054_0	14	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	054	0	1	04	01	H5141_054_0	14	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	22	22	22						22															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	054	0	1	04	01	H5141_054_0	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	054	0	1	04	01	H5141_054_0	14	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	055	0	1	04	01	H5141_055_0	13	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	055	0	1	04	01	H5141_055_0	13	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	055	0	1	04	01	H5141_055_0	13	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	22	22	22						22															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	055	0	1	04	01	H5141_055_0	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	055	0	1	04	01	H5141_055_0	13	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	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	6	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	6	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	6	Non-Medicare Rx Drugs	4	11			3	1	110		01	110		1	31		93				1	2	31		93				31		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5172	002	0	1	48	05	H5172_002_0	6	Non-Medicare OTC Drugs	4	11			4	1	110		01	110		1	31		93				1	2	31		93				31		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5178	001	0	1	01	01	H5178_001_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					8.00		24.00											15.00		45.00				8.00		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												
H5178	001	0	1	01	01	H5178_001_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5178	001	0	1	01	01	H5178_001_0	3	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				31.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5178	001	0	1	01	01	H5178_001_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	25		25				26.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5178	001	0	1	01	01	H5178_001_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	001	0	1	01	01	H5190_001_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	001	0	1	01	01	H5190_001_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	001	0	1	01	01	H5190_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	001	0	1	01	01	H5190_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				95.89	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	001	0	1	01	01	H5190_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	001	0	1	01	01	H5190_001_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	002	0	1	01	01	H5190_002_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	002	0	1	01	01	H5190_002_0	5	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	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	002	0	1	01	01	H5190_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	002	0	1	01	01	H5190_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				96.47	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	002	0	1	01	01	H5190_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	002	0	1	01	01	H5190_002_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	003	0	1	01	01	H5190_003_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	003	0	1	01	01	H5190_003_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	14.00	28.00	42.00																									14.00	28.00	42.00				14.00	28.00	0.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	003	0	1	01	01	H5190_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H5190	003	0	1	01	01	H5190_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				95.49	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	003	0	1	01	01	H5190_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	003	0	1	01	01	H5190_003_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	004	0	1	01	01	H5190_004_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	004	0	1	01	01	H5190_004_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	16.00	32.00	48.00																									16.00	32.00	48.00				16.00	32.00	0.00				16.00				16.00		0.53				0.53	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	004	0	1	01	01	H5190_004_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H5190	004	0	1	01	01	H5190_004_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				92.36	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	004	0	1	01	01	H5190_004_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	004	0	1	01	01	H5190_004_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	005	0	1	01	01	H5190_005_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	005	0	1	01	01	H5190_005_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	005	0	1	01	01	H5190_005_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H5190	005	0	1	01	01	H5190_005_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				95.30	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	005	0	1	01	01	H5190_005_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	005	0	1	01	01	H5190_005_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	006	0	1	01	01	H5190_006_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	006	0	1	01	01	H5190_006_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	006	0	1	01	01	H5190_006_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H5190	006	0	1	01	01	H5190_006_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				95.30	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	006	0	1	01	01	H5190_006_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	006	0	1	01	01	H5190_006_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	008	0	1	04	01	H5199_008_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	008	0	1	04	01	H5199_008_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5199	008	0	1	04	01	H5199_008_0	5	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					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												
H5199	008	0	1	04	01	H5199_008_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5199	008	0	1	04	01	H5199_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5199	008	0	1	04	01	H5199_008_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	008	0	1	04	01	H5199_008_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	008	0	1	04	01	H5199_008_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5199	010	0	1	04	01	H5199_010_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	010	0	1	04	01	H5199_010_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5199	010	0	1	04	01	H5199_010_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	010	0	1	04	01	H5199_010_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5199	010	0	1	04	01	H5199_010_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5199	010	0	1	04	01	H5199_010_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	010	0	1	04	01	H5199_010_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	010	0	1	04	01	H5199_010_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5199	012	0	1	04	01	H5199_012_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	012	0	1	04	01	H5199_012_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5199	012	0	1	04	01	H5199_012_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	012	0	1	04	01	H5199_012_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5199	012	0	1	04	01	H5199_012_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5199	012	0	1	04	01	H5199_012_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	012	0	1	04	01	H5199_012_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	012	0	1	04	01	H5199_012_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5199	013	0	1	04	01	H5199_013_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	013	0	1	04	01	H5199_013_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5199	013	0	1	04	01	H5199_013_0	5	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					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												
H5199	013	0	1	04	01	H5199_013_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H5199	013	0	1	04	01	H5199_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5199	013	0	1	04	01	H5199_013_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	013	0	1	04	01	H5199_013_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	013	0	1	04	01	H5199_013_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5199	014	0	1	04	01	H5199_014_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	014	0	1	04	01	H5199_014_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5199	014	0	1	04	01	H5199_014_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	014	0	1	04	01	H5199_014_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5199	014	0	1	04	01	H5199_014_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5199	014	0	1	04	01	H5199_014_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	014	0	1	04	01	H5199_014_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	014	0	1	04	01	H5199_014_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5199	015	0	1	04	01	H5199_015_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	015	0	1	04	01	H5199_015_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5199	015	0	1	04	01	H5199_015_0	5	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					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												
H5199	015	0	1	04	01	H5199_015_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H5199	015	0	1	04	01	H5199_015_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5199	015	0	1	04	01	H5199_015_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	015	0	1	04	01	H5199_015_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	015	0	1	04	01	H5199_015_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5199	016	0	1	04	01	H5199_016_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	016	0	1	04	01	H5199_016_0	6	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	016	0	1	04	01	H5199_016_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H5199	016	0	1	04	01	H5199_016_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				93.66	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	016	0	1	04	01	H5199_016_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5199	016	0	1	04	01	H5199_016_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5211	002	0	1	02	01	H5211_002_0	9	Preferred Generic	4	11	1	2	1	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	9	Generic	4	11	1	2	2	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	9.00	18.00	27.00																			9.00	18.00	27.00																9.00				9.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.38			1.38			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		2.94			2.94			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	34								34						34		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	9	Vaccines	4	11	1	2	6	1	010		01			1	34														34		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	8	Preferred Generic	4	11	1	2	1	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	9.00	18.00	27.00																			9.00	18.00	27.00																9.00				9.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	8	Generic	4	11	1	2	2	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.59			0.59			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.38			1.38			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		2.94			2.94			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	34								34						34		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	8	Vaccines	4	11	1	2	6	1	010		01			1	34														34		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	9	Preferred Generic	4	11	1	2	1	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.12			0.12			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	9	Generic	4	11	1	2	2	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	16.00	32.00	48.00																			16.00	32.00	48.00																16.00				16.00		0.47			0.47			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.38			1.38			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		2.94			2.94			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	34								34						34		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	9	Vaccines	4	11	1	2	6	1	010		01			1	34														34		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	8	Preferred Generic	4	11	1	2	1	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	013	0	1	02	01	H5211_013_0	8	Generic	4	11	1	2	2	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	9.00	18.00	27.00																			9.00	18.00	27.00																9.00				9.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	013	0	1	02	01	H5211_013_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.38			1.38			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	013	0	1	02	01	H5211_013_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	34	68	102				1	2	34	68	102				34		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		2.94			2.94			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	013	0	1	02	01	H5211_013_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	34								34						34		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	8	Vaccines	4	11	1	2	6	1	010		01			1	34														34		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	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		12.00					2.00		5.00											5.00		12.00				2.00		0.00				2.00				2.00			0.17	0.07		0.17	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		37.00					8.00		20.00											15.00		37.00				8.00		0.00				8.00				8.00			0.50	0.27		0.50	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	9	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		117.00					42.00		105.00											47.00		117.00				42.00		105.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	9	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		237.00											100.00		250.00				95.00		237.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	9	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												
H5215	005	0	1	04	01	H5215_005_0	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		12.00					2.00		5.00											5.00		12.00				2.00		0.00				2.00				2.00			0.17	0.07		0.17	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	7	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		37.00					8.00		20.00											15.00		37.00				8.00		0.00				8.00				8.00			0.50	0.27		0.50	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		117.00					42.00		105.00											47.00		117.00				42.00		105.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		250.00					95.00		237.00											100.00		250.00				95.00		237.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	8	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		20.00					5.00		12.00											8.00		20.00				5.00		0.00				5.00				5.00			0.27	0.17		0.27	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	8	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								17.00		42.00					10.00		25.00											17.00		42.00				10.00		0.00				10.00				10.00			0.57	0.33		0.57	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	8	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		117.00					42.00		105.00											47.00		117.00				42.00		105.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	8	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		250.00					95.00		237.00											100.00		250.00				95.00		237.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_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												
H5215	008	0	1	04	01	H5215_008_0	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		12.00					2.00		5.00											5.00		12.00				2.00		0.00				2.00				2.00			0.17	0.07		0.17	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	8	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		37.00					8.00		20.00											15.00		37.00				8.00		0.00				8.00				8.00			0.50	0.27		0.50	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		117.00					42.00		105.00											47.00		117.00				42.00		105.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		250.00					95.00		237.00											100.00		250.00				95.00		237.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		12.00					2.00		5.00											5.00		12.00				2.00		0.00				2.00				2.00			0.17	0.07		0.17	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		37.00					8.00		20.00											15.00		37.00				8.00		0.00				8.00				8.00			0.50	0.27		0.50	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	9	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		117.00					42.00		105.00											47.00		117.00				42.00		105.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	9	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		237.00											100.00		250.00				95.00		237.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		12.00					2.00		5.00											5.00		12.00				2.00		0.00				2.00				2.00			0.17	0.07		0.17	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	7	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		37.00					8.00		20.00											15.00		37.00				8.00		0.00				8.00				8.00			0.50	0.27		0.50	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		117.00					42.00		105.00											47.00		117.00				42.00		105.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		250.00					95.00		237.00											100.00		250.00				95.00		237.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	011	0	1	04	01	H5215_011_0	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		12.00					2.00		5.00											5.00		12.00				2.00		0.00				2.00				2.00			0.17	0.07		0.17	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	011	0	1	04	01	H5215_011_0	7	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		37.00					8.00		20.00											15.00		37.00				8.00		0.00				8.00				8.00			0.50	0.27		0.50	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	011	0	1	04	01	H5215_011_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		117.00					42.00		105.00											47.00		117.00				42.00		105.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	011	0	1	04	01	H5215_011_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		250.00					95.00		237.00											100.00		250.00				95.00		237.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	011	0	1	04	01	H5215_011_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	012	0	1	04	01	H5215_012_0	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		12.00					2.00		5.00											5.00		12.00				2.00		0.00				2.00				2.00			0.17	0.07		0.17	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	012	0	1	04	01	H5215_012_0	8	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		37.00					8.00		20.00											15.00		37.00				8.00		0.00				8.00				8.00			0.50	0.27		0.50	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	012	0	1	04	01	H5215_012_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		117.00					42.00		105.00											47.00		117.00				42.00		105.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	012	0	1	04	01	H5215_012_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		250.00					95.00		237.00											100.00		250.00				95.00		237.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	012	0	1	04	01	H5215_012_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	022	0	1	04	01	H5216_022_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	022	0	1	04	01	H5216_022_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	022	0	1	04	01	H5216_022_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	022	0	1	04	01	H5216_022_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_023_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_023_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_023_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_023_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_029_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_029_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	1	1	04	01	H5216_033_1	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	1	1	04	01	H5216_033_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	2	1	04	01	H5216_033_2	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	2	1	04	01	H5216_033_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	2	1	04	01	H5216_033_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	2	1	04	01	H5216_033_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	036	0	1	04	01	H5216_036_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	036	0	1	04	01	H5216_036_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	036	0	1	04	01	H5216_036_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	036	0	1	04	01	H5216_036_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	036	0	1	04	01	H5216_036_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_039_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_039_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_039_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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
H5216	043	1	1	04	01	H5216_043_1	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	043	1	1	04	01	H5216_043_1	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	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	043	2	1	04	01	H5216_043_2	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	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
H5216	043	2	1	04	01	H5216_043_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	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		
H5216	043	2	1	04	01	H5216_043_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	2	1	04	01	H5216_043_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	2	1	04	01	H5216_043_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4	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	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	048	0	1	04	01	H5216_048_0	4	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	25		25				26.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	048	0	1	04	01	H5216_048_0	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											23.00	25		25				23.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	048	0	1	04	01	H5216_048_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	050	0	1	04	01	H5216_050_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	050	0	1	04	01	H5216_050_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	050	0	1	04	01	H5216_050_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	050	0	1	04	01	H5216_050_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	051	0	1	04	01	H5216_051_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	051	0	1	04	01	H5216_051_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	051	0	1	04	01	H5216_051_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	051	0	1	04	01	H5216_051_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	051	0	1	04	01	H5216_051_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	1	1	04	01	H5216_052_1	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	1	1	04	01	H5216_052_1	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	1	1	04	01	H5216_052_1	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	1	1	04	01	H5216_052_1	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	2	1	04	01	H5216_052_2	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	2	1	04	01	H5216_052_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	2	1	04	01	H5216_052_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	2	1	04	01	H5216_052_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	053	0	1	04	01	H5216_053_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	053	0	1	04	01	H5216_053_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	053	0	1	04	01	H5216_053_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	053	0	1	04	01	H5216_053_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	053	0	1	04	01	H5216_053_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	054	0	1	04	01	H5216_054_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	054	0	1	04	01	H5216_054_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	054	0	1	04	01	H5216_054_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	054	0	1	04	01	H5216_054_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	054	0	1	04	01	H5216_054_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	055	0	1	04	01	H5216_055_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	055	0	1	04	01	H5216_055_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	055	0	1	04	01	H5216_055_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	055	0	1	04	01	H5216_055_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	063	0	1	04	01	H5216_063_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	064	0	1	04	01	H5216_064_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	Non-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	Specialty Tier	4	11	1	1	5	1		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	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	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	Non-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	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	068	0	1	04	01	H5216_068_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	068	0	1	04	01	H5216_068_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	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	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	070	0	1	04	01	H5216_070_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	070	0	1	04	01	H5216_070_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	071	0	1	04	01	H5216_071_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	071	0	1	04	01	H5216_071_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	071	0	1	04	01	H5216_071_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	071	0	1	04	01	H5216_071_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	071	0	1	04	01	H5216_071_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	074	0	1	04	01	H5216_074_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	074	0	1	04	01	H5216_074_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	075	0	1	04	01	H5216_075_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	075	0	1	04	01	H5216_075_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	075	0	1	04	01	H5216_075_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	075	0	1	04	01	H5216_075_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	075	0	1	04	01	H5216_075_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	1	1	04	01	H5216_080_1	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	1	1	04	01	H5216_080_1	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	1	1	04	01	H5216_080_1	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	1	1	04	01	H5216_080_1	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	1	1	04	01	H5216_080_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	2	1	04	01	H5216_080_2	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	2	1	04	01	H5216_080_2	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	2	1	04	01	H5216_080_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	2	1	04	01	H5216_080_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	3	1	04	01	H5216_080_3	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	3	1	04	01	H5216_080_3	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	3	1	04	01	H5216_080_3	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	3	1	04	01	H5216_080_3	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	3	1	04	01	H5216_080_3	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											45.00	50		50				45.00	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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	109	0	1	04	01	H5216_109_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	109	0	1	04	01	H5216_109_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	109	0	1	04	01	H5216_109_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	109	0	1	04	01	H5216_109_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	109	0	1	04	01	H5216_109_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	111	0	1	04	01	H5216_111_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	111	0	1	04	01	H5216_111_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	111	0	1	04	01	H5216_111_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	111	0	1	04	01	H5216_111_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	111	0	1	04	01	H5216_111_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	114	0	1	04	01	H5216_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					0.00		0.00											10.00		30.00				0.00		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	114	0	1	04	01	H5216_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					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	114	0	1	04	01	H5216_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												
H5216	114	0	1	04	01	H5216_114_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	115	0	1	04	01	H5216_115_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					4.00		12.00											5.00		15.00				4.00		0.00				5.00				5.00			0.17	0.13		0.17	0.13	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	115	0	1	04	01	H5216_115_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	115	0	1	04	01	H5216_115_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	115	0	1	04	01	H5216_115_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	115	0	1	04	01	H5216_115_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	117	0	1	04	01	H5216_117_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	117	0	1	04	01	H5216_117_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	117	0	1	04	01	H5216_117_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	117	0	1	04	01	H5216_117_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	125	0	1	04	01	H5216_125_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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												
H5216	125	0	1	04	01	H5216_125_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	125	0	1	04	01	H5216_125_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	125	0	1	04	01	H5216_125_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	131	0	1	04	01	H5216_131_0	4	Preferred Generic	4	11	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	131	0	1	04	01	H5216_131_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	131	0	1	04	01	H5216_131_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	131	0	1	04	01	H5216_131_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	132	0	1	04	01	H5216_132_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	132	0	1	04	01	H5216_132_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	132	0	1	04	01	H5216_132_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	132	0	1	04	01	H5216_132_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_0	5	Generic	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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	141	0	1	04	01	H5216_141_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_1	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_1	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_1	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	143	0	1	04	01	H5216_143_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	143	0	1	04	01	H5216_143_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	143	0	1	04	01	H5216_143_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	149	0	1	04	01	H5216_149_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	149	0	1	04	01	H5216_149_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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												
H5216	149	0	1	04	01	H5216_149_0	7	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	154	0	1	04	01	H5216_154_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	158	0	1	04	01	H5216_158_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	158	0	1	04	01	H5216_158_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	158	0	1	04	01	H5216_158_0	5	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	22		22				26.00	22		22										22		22				22		22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	158	0	1	04	01	H5216_158_0	5	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											23.00	22		22				23.00	22		22										22		22				22		22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	158	0	1	04	01	H5216_158_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_0	4	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	160	0	1	04	01	H5216_160_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					6.00		18.00											18.00		54.00				6.00		0.00				18.00				18.00			0.60	0.20		0.60	0.20	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	163	0	1	04	01	H5216_163_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	163	0	1	04	01	H5216_163_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	163	0	1	04	01	H5216_163_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	164	0	1	04	01	H5216_164_0	7	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	164	0	1	04	01	H5216_164_0	7	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	7	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	164	0	1	04	01	H5216_164_0	7	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	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	7	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	7	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	7	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	165	0	1	04	01	H5216_165_0	7	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	166	0	1	04	01	H5216_166_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	166	0	1	04	01	H5216_166_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	168	0	1	04	01	H5216_168_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	171	0	1	04	01	H5216_171_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	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	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	175	0	1	04	01	H5216_175_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	175	0	1	04	01	H5216_175_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	5	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	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	181	0	1	04	01	H5216_181_0	6	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	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	6	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	181	0	1	04	01	H5216_181_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	181	0	1	04	01	H5216_181_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	192	0	1	04	01	H5216_192_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	195	0	1	04	01	H5216_195_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	195	0	1	04	01	H5216_195_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	195	0	1	04	01	H5216_195_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_1	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	197	0	1	04	01	H5216_197_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	199	0	1	04	01	H5216_199_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	199	0	1	04	01	H5216_199_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	199	0	1	04	01	H5216_199_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	202	0	1	04	01	H5216_202_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	202	0	1	04	01	H5216_202_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	202	0	1	04	01	H5216_202_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	202	0	1	04	01	H5216_202_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	202	0	1	04	01	H5216_202_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	1	1	04	01	H5216_203_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	1	1	04	01	H5216_203_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	1	1	04	01	H5216_203_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	1	1	04	01	H5216_203_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	1	1	04	01	H5216_203_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	2	1	04	01	H5216_203_2	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	2	1	04	01	H5216_203_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	2	1	04	01	H5216_203_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	2	1	04	01	H5216_203_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	2	1	04	01	H5216_203_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	205	0	1	04	01	H5216_205_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	7	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	205	0	1	04	01	H5216_205_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	205	0	1	04	01	H5216_205_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		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	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	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	206	0	1	04	01	H5216_206_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	Specialty Tier	4	11	1	1	5	1		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	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	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	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	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	211	0	1	04	01	H5216_211_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	211	0	1	04	01	H5216_211_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	211	0	1	04	01	H5216_211_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	211	0	1	04	01	H5216_211_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	211	0	1	04	01	H5216_211_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	212	0	1	04	01	H5216_212_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	212	0	1	04	01	H5216_212_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	212	0	1	04	01	H5216_212_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	3	1	04	01	H5216_214_3	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	3	1	04	01	H5216_214_3	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	3	1	04	01	H5216_214_3	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	215	0	1	04	01	H5216_215_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	215	0	1	04	01	H5216_215_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	219	0	1	04	01	H5216_219_0	7	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	219	0	1	04	01	H5216_219_0	7	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	7	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	219	0	1	04	01	H5216_219_0	7	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	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	7	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												
H5216	220	0	1	04	01	H5216_220_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	220	0	1	04	01	H5216_220_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	220	0	1	04	01	H5216_220_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	222	0	1	04	01	H5216_222_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	222	0	1	04	01	H5216_222_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	223	0	1	04	01	H5216_223_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	223	0	1	04	01	H5216_223_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	226	0	1	04	01	H5216_226_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	226	0	1	04	01	H5216_226_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	226	0	1	04	01	H5216_226_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	Specialty Tier	4	11	1	1	5	1		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	227	0	1	04	01	H5216_227_0	6	Preferred Generic	4	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	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	227	0	1	04	01	H5216_227_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	227	0	1	04	01	H5216_227_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	227	0	1	04	01	H5216_227_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	228	0	1	04	01	H5216_228_0	8	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	228	0	1	04	01	H5216_228_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					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	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												
H5216	228	0	1	04	01	H5216_228_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												
H5216	228	0	1	04	01	H5216_228_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												
H5216	229	0	1	04	01	H5216_229_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	229	0	1	04	01	H5216_229_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	229	0	1	04	01	H5216_229_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	229	0	1	04	01	H5216_229_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	229	0	1	04	01	H5216_229_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	230	0	1	04	01	H5216_230_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	230	0	1	04	01	H5216_230_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	230	0	1	04	01	H5216_230_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	231	0	1	04	01	H5216_231_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	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	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	Non-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	Specialty Tier	4	11	1	1	5	1		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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	1	1	04	01	H5216_232_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	1	1	04	01	H5216_232_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	1	1	04	01	H5216_232_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	1	1	04	01	H5216_232_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	2	1	04	01	H5216_232_2	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	2	1	04	01	H5216_232_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	2	1	04	01	H5216_232_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	2	1	04	01	H5216_232_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	1	1	04	01	H5216_233_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	1	1	04	01	H5216_233_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	1	1	04	01	H5216_233_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	1	1	04	01	H5216_233_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	1	1	04	01	H5216_233_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	2	1	04	01	H5216_233_2	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	2	1	04	01	H5216_233_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	2	1	04	01	H5216_233_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	2	1	04	01	H5216_233_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	2	1	04	01	H5216_233_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	1	1	04	01	H5216_237_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	1	1	04	01	H5216_237_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	2	1	04	01	H5216_237_2	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	2	1	04	01	H5216_237_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	239	0	1	04	01	H5216_239_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	239	0	1	04	01	H5216_239_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	239	0	1	04	01	H5216_239_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	240	0	1	04	01	H5216_240_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	240	0	1	04	01	H5216_240_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	240	0	1	04	01	H5216_240_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	240	0	1	04	01	H5216_240_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	240	0	1	04	01	H5216_240_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	242	0	1	04	01	H5216_242_0	6	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	242	0	1	04	01	H5216_242_0	6	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	242	0	1	04	01	H5216_242_0	6	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	242	0	1	04	01	H5216_242_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	242	0	1	04	01	H5216_242_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	243	0	1	04	01	H5216_243_0	6	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	243	0	1	04	01	H5216_243_0	6	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	243	0	1	04	01	H5216_243_0	6	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	243	0	1	04	01	H5216_243_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	243	0	1	04	01	H5216_243_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	244	0	1	04	01	H5216_244_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	244	0	1	04	01	H5216_244_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	244	0	1	04	01	H5216_244_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	244	0	1	04	01	H5216_244_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	244	0	1	04	01	H5216_244_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	246	0	1	04	01	H5216_246_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	246	0	1	04	01	H5216_246_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	246	0	1	04	01	H5216_246_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	246	0	1	04	01	H5216_246_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	246	0	1	04	01	H5216_246_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	247	0	1	04	01	H5216_247_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	247	0	1	04	01	H5216_247_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	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	248	1	1	04	01	H5216_248_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	1	1	04	01	H5216_248_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	1	1	04	01	H5216_248_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	1	1	04	01	H5216_248_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	1	1	04	01	H5216_248_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	2	1	04	01	H5216_248_2	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	2	1	04	01	H5216_248_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	2	1	04	01	H5216_248_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	2	1	04	01	H5216_248_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	2	1	04	01	H5216_248_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	249	0	1	04	01	H5216_249_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	249	0	1	04	01	H5216_249_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	249	0	1	04	01	H5216_249_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	250	0	1	04	01	H5216_250_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	250	0	1	04	01	H5216_250_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	250	0	1	04	01	H5216_250_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	251	0	1	04	01	H5216_251_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	251	0	1	04	01	H5216_251_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	251	0	1	04	01	H5216_251_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	252	0	1	04	01	H5216_252_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	252	0	1	04	01	H5216_252_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	252	0	1	04	01	H5216_252_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	253	0	1	04	01	H5216_253_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	253	0	1	04	01	H5216_253_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	253	0	1	04	01	H5216_253_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	254	0	1	04	01	H5216_254_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	254	0	1	04	01	H5216_254_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	254	0	1	04	01	H5216_254_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	254	0	1	04	01	H5216_254_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	254	0	1	04	01	H5216_254_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	255	0	1	04	01	H5216_255_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	255	0	1	04	01	H5216_255_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	255	0	1	04	01	H5216_255_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	260	0	1	04	01	H5216_260_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	260	0	1	04	01	H5216_260_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	260	0	1	04	01	H5216_260_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	260	0	1	04	01	H5216_260_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	260	0	1	04	01	H5216_260_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	261	0	1	04	01	H5216_261_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	261	0	1	04	01	H5216_261_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	261	0	1	04	01	H5216_261_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	261	0	1	04	01	H5216_261_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	261	0	1	04	01	H5216_261_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	262	0	1	04	01	H5216_262_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	262	0	1	04	01	H5216_262_0	5	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	262	0	1	04	01	H5216_262_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	262	0	1	04	01	H5216_262_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	262	0	1	04	01	H5216_262_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	263	0	1	04	01	H5216_263_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	263	0	1	04	01	H5216_263_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	263	0	1	04	01	H5216_263_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	263	0	1	04	01	H5216_263_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	263	0	1	04	01	H5216_263_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	264	0	1	04	01	H5216_264_0	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	264	0	1	04	01	H5216_264_0	3	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	264	0	1	04	01	H5216_264_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	264	0	1	04	01	H5216_264_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	264	0	1	04	01	H5216_264_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	265	0	1	04	01	H5216_265_0	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	265	0	1	04	01	H5216_265_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	265	0	1	04	01	H5216_265_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	265	0	1	04	01	H5216_265_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	265	0	1	04	01	H5216_265_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	266	0	1	04	01	H5216_266_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	266	0	1	04	01	H5216_266_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	266	0	1	04	01	H5216_266_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	266	0	1	04	01	H5216_266_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	266	0	1	04	01	H5216_266_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	267	0	1	04	01	H5216_267_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					8.00		24.00											19.00		57.00				8.00		0.00				19.00				19.00			0.63	0.27		0.63	0.27	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	267	0	1	04	01	H5216_267_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	267	0	1	04	01	H5216_267_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	267	0	1	04	01	H5216_267_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	267	0	1	04	01	H5216_267_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	268	0	1	04	01	H5216_268_0	7	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	268	0	1	04	01	H5216_268_0	7	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	268	0	1	04	01	H5216_268_0	7	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	268	0	1	04	01	H5216_268_0	7	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	268	0	1	04	01	H5216_268_0	7	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	269	0	1	04	01	H5216_269_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	269	0	1	04	01	H5216_269_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	269	0	1	04	01	H5216_269_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	269	0	1	04	01	H5216_269_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	269	0	1	04	01	H5216_269_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	270	1	1	04	01	H5216_270_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	270	1	1	04	01	H5216_270_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	270	1	1	04	01	H5216_270_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	270	1	1	04	01	H5216_270_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	270	1	1	04	01	H5216_270_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	270	2	1	04	01	H5216_270_2	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	270	2	1	04	01	H5216_270_2	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	270	2	1	04	01	H5216_270_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	270	2	1	04	01	H5216_270_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	270	2	1	04	01	H5216_270_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	271	0	1	04	01	H5216_271_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	271	0	1	04	01	H5216_271_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	271	0	1	04	01	H5216_271_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	271	0	1	04	01	H5216_271_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	271	0	1	04	01	H5216_271_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	272	0	1	04	01	H5216_272_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	272	0	1	04	01	H5216_272_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	272	0	1	04	01	H5216_272_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	272	0	1	04	01	H5216_272_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	272	0	1	04	01	H5216_272_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	273	0	1	04	01	H5216_273_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	273	0	1	04	01	H5216_273_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	273	0	1	04	01	H5216_273_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	273	0	1	04	01	H5216_273_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	273	0	1	04	01	H5216_273_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	274	0	1	04	01	H5216_274_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	274	0	1	04	01	H5216_274_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	274	0	1	04	01	H5216_274_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	274	0	1	04	01	H5216_274_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	274	0	1	04	01	H5216_274_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	275	0	1	04	01	H5216_275_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	275	0	1	04	01	H5216_275_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	275	0	1	04	01	H5216_275_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	275	0	1	04	01	H5216_275_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	275	0	1	04	01	H5216_275_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	277	0	1	04	01	H5216_277_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	277	0	1	04	01	H5216_277_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	277	0	1	04	01	H5216_277_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	277	0	1	04	01	H5216_277_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	277	0	1	04	01	H5216_277_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	279	0	1	04	01	H5216_279_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	279	0	1	04	01	H5216_279_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	279	0	1	04	01	H5216_279_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	279	0	1	04	01	H5216_279_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	279	0	1	04	01	H5216_279_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	280	1	1	04	01	H5216_280_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	280	1	1	04	01	H5216_280_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	280	1	1	04	01	H5216_280_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	280	1	1	04	01	H5216_280_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	280	1	1	04	01	H5216_280_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	280	2	1	04	01	H5216_280_2	5	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	280	2	1	04	01	H5216_280_2	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	280	2	1	04	01	H5216_280_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	280	2	1	04	01	H5216_280_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	280	2	1	04	01	H5216_280_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	281	0	1	04	01	H5216_281_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	281	0	1	04	01	H5216_281_0	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	281	0	1	04	01	H5216_281_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	281	0	1	04	01	H5216_281_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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		
H5216	281	0	1	04	01	H5216_281_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	281	0	1	04	01	H5216_281_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	281	0	1	04	01	H5216_281_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	282	1	1	04	01	H5216_282_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	282	1	1	04	01	H5216_282_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	282	1	1	04	01	H5216_282_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	282	1	1	04	01	H5216_282_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	282	1	1	04	01	H5216_282_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	282	2	1	04	01	H5216_282_2	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	282	2	1	04	01	H5216_282_2	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	282	2	1	04	01	H5216_282_2	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	282	2	1	04	01	H5216_282_2	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	282	2	1	04	01	H5216_282_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	283	0	1	04	01	H5216_283_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	283	0	1	04	01	H5216_283_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	283	0	1	04	01	H5216_283_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	283	0	1	04	01	H5216_283_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	283	0	1	04	01	H5216_283_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	284	0	1	04	01	H5216_284_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	284	0	1	04	01	H5216_284_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	284	0	1	04	01	H5216_284_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	284	0	1	04	01	H5216_284_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	284	0	1	04	01	H5216_284_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	285	0	1	04	01	H5216_285_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	285	0	1	04	01	H5216_285_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	285	0	1	04	01	H5216_285_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	285	0	1	04	01	H5216_285_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	285	0	1	04	01	H5216_285_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	287	0	1	04	01	H5216_287_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	287	0	1	04	01	H5216_287_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	287	0	1	04	01	H5216_287_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	287	0	1	04	01	H5216_287_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	287	0	1	04	01	H5216_287_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	288	0	1	04	01	H5216_288_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	288	0	1	04	01	H5216_288_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	288	0	1	04	01	H5216_288_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	288	0	1	04	01	H5216_288_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	288	0	1	04	01	H5216_288_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	289	0	1	04	01	H5216_289_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	289	0	1	04	01	H5216_289_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	289	0	1	04	01	H5216_289_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	289	0	1	04	01	H5216_289_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	289	0	1	04	01	H5216_289_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	290	0	1	04	01	H5216_290_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					2.00		6.00											15.00		45.00				2.00		0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	290	0	1	04	01	H5216_290_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	290	0	1	04	01	H5216_290_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	290	0	1	04	01	H5216_290_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	290	0	1	04	01	H5216_290_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	291	0	1	04	01	H5216_291_0	5	Preferred Generic	4	11	1	2	1	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		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												
H5216	291	0	1	04	01	H5216_291_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					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	291	0	1	04	01	H5216_291_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	291	0	1	04	01	H5216_291_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	291	0	1	04	01	H5216_291_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	292	0	1	04	01	H5216_292_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	292	0	1	04	01	H5216_292_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	292	0	1	04	01	H5216_292_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	292	0	1	04	01	H5216_292_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	292	0	1	04	01	H5216_292_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	293	0	1	04	01	H5216_293_0	6	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	293	0	1	04	01	H5216_293_0	6	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	293	0	1	04	01	H5216_293_0	6	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				27.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	293	0	1	04	01	H5216_293_0	6	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				29.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	293	0	1	04	01	H5216_293_0	6	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	294	0	1	04	01	H5216_294_0	6	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	294	0	1	04	01	H5216_294_0	6	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	294	0	1	04	01	H5216_294_0	6	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	25		25				30.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	294	0	1	04	01	H5216_294_0	6	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				31.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	294	0	1	04	01	H5216_294_0	6	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	295	0	1	04	01	H5216_295_0	6	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	295	0	1	04	01	H5216_295_0	6	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	295	0	1	04	01	H5216_295_0	6	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				28.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	295	0	1	04	01	H5216_295_0	6	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				29.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	295	0	1	04	01	H5216_295_0	6	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	296	0	1	04	01	H5216_296_0	9	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	296	0	1	04	01	H5216_296_0	9	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	296	0	1	04	01	H5216_296_0	9	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	296	0	1	04	01	H5216_296_0	9	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	296	0	1	04	01	H5216_296_0	9	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	298	0	1	04	01	H5216_298_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					8.00		24.00											18.00		54.00				8.00		0.00				18.00				18.00			0.60	0.27		0.60	0.27	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	298	0	1	04	01	H5216_298_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	298	0	1	04	01	H5216_298_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	298	0	1	04	01	H5216_298_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	298	0	1	04	01	H5216_298_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	300	0	1	04	01	H5216_300_0	3	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			0.50	0		0.50	0	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	300	0	1	04	01	H5216_300_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	300	0	1	04	01	H5216_300_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	300	0	1	04	01	H5216_300_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	300	0	1	04	01	H5216_300_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	302	0	1	04	01	H5216_302_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		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												
H5216	302	0	1	04	01	H5216_302_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	302	0	1	04	01	H5216_302_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	302	0	1	04	01	H5216_302_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	302	0	1	04	01	H5216_302_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	303	0	1	04	01	H5216_303_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	303	0	1	04	01	H5216_303_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	303	0	1	04	01	H5216_303_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	303	0	1	04	01	H5216_303_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	303	0	1	04	01	H5216_303_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5232	001	0	1	04	01	H5232_001_0	6	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5232	001	0	1	04	01	H5232_001_0	6	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5232	001	0	1	04	01	H5232_001_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5232	001	0	1	04	01	H5232_001_0	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5232	001	0	1	04	01	H5232_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		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	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1474.51	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	02	01	H5253_004_0	5	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	004	0	1	02	01	H5253_004_0	5	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	004	0	1	02	01	H5253_004_0	5	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	5	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	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												
H5253	004	0	1	02	01	H5253_004_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												
H5253	004	0	1	02	01	H5253_004_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				289.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	011	0	1	02	01	H5253_011_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	011	0	1	02	01	H5253_011_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	4	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												
H5253	030	0	1	02	01	H5253_030_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	030	0	1	02	01	H5253_030_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	030	0	1	02	01	H5253_030_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				238.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	02	01	H5253_033_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	02	01	H5253_033_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	033	0	1	02	01	H5253_033_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				262.00	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	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	034	0	1	02	01	H5253_034_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	034	0	1	02	01	H5253_034_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				319.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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	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		
H5253	035	0	1	02	01	H5253_035_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				533.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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	036	0	1	01	01	H5253_036_0	3	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		
H5253	036	0	1	01	01	H5253_036_0	3	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												
H5253	036	0	1	01	01	H5253_036_0	3	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
H5253	036	0	1	01	01	H5253_036_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	3	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	037	0	1	02	01	H5253_037_0	5	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	037	0	1	02	01	H5253_037_0	5	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	037	0	1	02	01	H5253_037_0	5	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	02	01	H5253_037_0	5	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	037	0	1	02	01	H5253_037_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												
H5253	037	0	1	02	01	H5253_037_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												
H5253	037	0	1	02	01	H5253_037_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				411.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	02	01	H5253_038_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	02	01	H5253_038_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	038	0	1	02	01	H5253_038_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	02	01	H5253_038_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	038	0	1	02	01	H5253_038_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	02	01	H5253_038_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				383.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	02	01	H5253_039_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	02	01	H5253_039_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	039	0	1	02	01	H5253_039_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	02	01	H5253_039_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	039	0	1	02	01	H5253_039_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	02	01	H5253_039_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				316.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	043	0	1	02	01	H5253_043_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3	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												
H5253	047	0	1	01	01	H5253_047_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	047	0	1	01	01	H5253_047_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	047	0	1	01	01	H5253_047_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				392.00	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	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	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	048	0	1	01	01	H5253_048_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	01	01	H5253_048_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	048	0	1	01	01	H5253_048_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	01	01	H5253_048_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	01	01	H5253_048_0	3	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												
H5253	049	0	1	01	01	H5253_049_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3	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		
H5253	049	0	1	01	01	H5253_049_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	049	0	1	01	01	H5253_049_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				255.00	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	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	050	0	1	01	01	H5253_050_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	050	0	1	01	01	H5253_050_0	3	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												
H5253	050	0	1	01	01	H5253_050_0	3	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
H5253	050	0	1	01	01	H5253_050_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	3	Specialty Tier	4	11	1	1	5	1	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												
H5253	051	0	1	01	01	H5253_051_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	051	0	1	01	01	H5253_051_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5253	051	0	1	01	01	H5253_051_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	3	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												
H5253	052	0	1	01	01	H5253_052_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		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	052	0	1	01	01	H5253_052_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	052	0	1	01	01	H5253_052_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	052	0	1	01	01	H5253_052_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	3	Specialty Tier	4	11	1	1	5	1	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												
H5253	061	0	1	02	01	H5253_061_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	3	Generic	4	01	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	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	061	0	1	02	01	H5253_061_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	3	Specialty Tier	4	11	1	1	5	1	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												
H5253	062	0	1	01	01	H5253_062_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	4	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		
H5253	062	0	1	01	01	H5253_062_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	062	0	1	01	01	H5253_062_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				368.00	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	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	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	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												
H5253	072	0	1	02	01	H5253_072_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	02	01	H5253_072_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H5253	072	0	1	02	01	H5253_072_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				365.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	02	01	H5253_073_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	02	01	H5253_073_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	073	0	1	02	01	H5253_073_0	3	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	073	0	1	02	01	H5253_073_0	3	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	073	0	1	02	01	H5253_073_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	02	01	H5253_073_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				178.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	02	01	H5253_079_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	02	01	H5253_079_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	079	0	1	02	01	H5253_079_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	02	01	H5253_079_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	079	0	1	02	01	H5253_079_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	02	01	H5253_079_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				283.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	080	0	1	02	01	H5253_080_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	080	0	1	02	01	H5253_080_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				546.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	01	01	H5253_081_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		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	081	0	1	01	01	H5253_081_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	081	0	1	01	01	H5253_081_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	01	01	H5253_081_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	01	01	H5253_081_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				412.00	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	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	082	0	1	01	01	H5253_082_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	082	0	1	01	01	H5253_082_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	01	01	H5253_082_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	01	01	H5253_082_0	3	Specialty Tier	4	11	1	1	5	1	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												
H5253	083	0	1	01	01	H5253_083_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		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	083	0	1	01	01	H5253_083_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	083	0	1	01	01	H5253_083_0	3	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												
H5253	083	0	1	01	01	H5253_083_0	3	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
H5253	083	0	1	01	01	H5253_083_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	01	01	H5253_083_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	01	01	H5253_083_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				390.00	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	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	084	0	1	01	01	H5253_084_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	084	0	1	01	01	H5253_084_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	01	01	H5253_084_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	084	0	1	01	01	H5253_084_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	01	01	H5253_084_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	01	01	H5253_084_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				379.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	02	01	H5253_087_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	02	01	H5253_087_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	087	0	1	02	01	H5253_087_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	02	01	H5253_087_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	087	0	1	02	01	H5253_087_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	02	01	H5253_087_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				459.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	02	01	H5253_088_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	02	01	H5253_088_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	088	0	1	02	01	H5253_088_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	02	01	H5253_088_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	088	0	1	02	01	H5253_088_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	02	01	H5253_088_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				486.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	02	01	H5253_089_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	02	01	H5253_089_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	089	0	1	02	01	H5253_089_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	089	0	1	02	01	H5253_089_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	02	01	H5253_089_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	4	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												
H5253	097	0	1	02	01	H5253_097_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	097	0	1	02	01	H5253_097_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H5253	097	0	1	02	01	H5253_097_0	3	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	02	01	H5253_097_0	3	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	02	01	H5253_097_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	097	0	1	02	01	H5253_097_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	097	0	1	02	01	H5253_097_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				219.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	01	01	H5253_099_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	01	01	H5253_099_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	099	0	1	01	01	H5253_099_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	01	01	H5253_099_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	099	0	1	01	01	H5253_099_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	01	01	H5253_099_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	01	01	H5253_099_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				487.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	01	01	H5253_100_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	01	01	H5253_100_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	100	0	1	01	01	H5253_100_0	3	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												
H5253	100	0	1	01	01	H5253_100_0	3	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
H5253	100	0	1	01	01	H5253_100_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	01	01	H5253_100_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	01	01	H5253_100_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				468.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	02	01	H5253_102_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	02	01	H5253_102_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	102	0	1	02	01	H5253_102_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	02	01	H5253_102_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	102	0	1	02	01	H5253_102_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	02	01	H5253_102_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	02	01	H5253_102_0	4	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												
H5253	103	0	1	02	01	H5253_103_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	02	01	H5253_103_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	103	0	1	02	01	H5253_103_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	02	01	H5253_103_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	103	0	1	02	01	H5253_103_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	02	01	H5253_103_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	02	01	H5253_103_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				300.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	02	01	H5253_104_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	02	01	H5253_104_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	104	0	1	02	01	H5253_104_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	02	01	H5253_104_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	104	0	1	02	01	H5253_104_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	02	01	H5253_104_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	02	01	H5253_104_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				493.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	02	01	H5253_105_0	4	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	4	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		
H5253	105	0	1	02	01	H5253_105_0	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											265.00	25						226.00	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	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												
H5253	107	1	1	02	01	H5253_107_1	3	Preferred Generic	4	01	1	2	1	3	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										1		
H5253	107	1	1	02	01	H5253_107_1	3	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												
H5253	107	1	1	02	01	H5253_107_1	3	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
H5253	107	1	1	02	01	H5253_107_1	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	1	1	02	01	H5253_107_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	1	1	02	01	H5253_107_1	3	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												
H5253	107	2	1	02	01	H5253_107_2	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	2	1	02	01	H5253_107_2	3	Preferred Generic	4	01	1	2	1	3	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										1		
H5253	107	2	1	02	01	H5253_107_2	3	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												
H5253	107	2	1	02	01	H5253_107_2	3	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
H5253	107	2	1	02	01	H5253_107_2	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	2	1	02	01	H5253_107_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	2	1	02	01	H5253_107_2	3	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												
H5253	108	1	1	02	01	H5253_108_1	3	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	108	1	1	02	01	H5253_108_1	3	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		
H5253	108	1	1	02	01	H5253_108_1	3	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												
H5253	108	1	1	02	01	H5253_108_1	3	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
H5253	108	1	1	02	01	H5253_108_1	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	1	1	02	01	H5253_108_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	1	1	02	01	H5253_108_1	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				324.00	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	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	108	2	1	02	01	H5253_108_2	3	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		
H5253	108	2	1	02	01	H5253_108_2	3	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												
H5253	108	2	1	02	01	H5253_108_2	3	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
H5253	108	2	1	02	01	H5253_108_2	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	2	1	02	01	H5253_108_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	2	1	02	01	H5253_108_2	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				324.00	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	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	108	3	1	02	01	H5253_108_3	3	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		
H5253	108	3	1	02	01	H5253_108_3	3	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												
H5253	108	3	1	02	01	H5253_108_3	3	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
H5253	108	3	1	02	01	H5253_108_3	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	3	1	02	01	H5253_108_3	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	3	1	02	01	H5253_108_3	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				324.00	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	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	109	1	1	01	01	H5253_109_1	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	109	1	1	01	01	H5253_109_1	3	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	109	1	1	01	01	H5253_109_1	3	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										1		3
H5253	109	1	1	01	01	H5253_109_1	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	1	1	01	01	H5253_109_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	1	1	01	01	H5253_109_1	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				377.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	2	1	01	01	H5253_109_2	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	2	1	01	01	H5253_109_2	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	109	2	1	01	01	H5253_109_2	3	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	109	2	1	01	01	H5253_109_2	3	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										1		3
H5253	109	2	1	01	01	H5253_109_2	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	2	1	01	01	H5253_109_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	2	1	01	01	H5253_109_2	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				377.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	110	0	1	02	01	H5253_110_0	4	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	4	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		
H5253	110	0	1	02	01	H5253_110_0	4	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												
H5253	110	0	1	02	01	H5253_110_0	4	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
H5253	110	0	1	02	01	H5253_110_0	4	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											269.00	25						218.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	1	1	02	01	H5253_111_1	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	1	1	02	01	H5253_111_1	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	111	1	1	02	01	H5253_111_1	4	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												
H5253	111	1	1	02	01	H5253_111_1	4	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
H5253	111	1	1	02	01	H5253_111_1	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	1	1	02	01	H5253_111_1	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	1	1	02	01	H5253_111_1	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				446.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	2	1	02	01	H5253_111_2	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	2	1	02	01	H5253_111_2	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	111	2	1	02	01	H5253_111_2	4	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												
H5253	111	2	1	02	01	H5253_111_2	4	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
H5253	111	2	1	02	01	H5253_111_2	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	2	1	02	01	H5253_111_2	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	2	1	02	01	H5253_111_2	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				446.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	1	1	02	01	H5253_112_1	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	1	1	02	01	H5253_112_1	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	112	1	1	02	01	H5253_112_1	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	1	1	02	01	H5253_112_1	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	112	1	1	02	01	H5253_112_1	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	1	1	02	01	H5253_112_1	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	1	1	02	01	H5253_112_1	4	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												
H5253	112	2	1	02	01	H5253_112_2	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	2	1	02	01	H5253_112_2	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	112	2	1	02	01	H5253_112_2	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	2	1	02	01	H5253_112_2	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	112	2	1	02	01	H5253_112_2	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	2	1	02	01	H5253_112_2	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	2	1	02	01	H5253_112_2	4	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												
H5253	115	0	1	01	01	H5253_115_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	115	0	1	01	01	H5253_115_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	115	0	1	01	01	H5253_115_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	115	0	1	01	01	H5253_115_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	115	0	1	01	01	H5253_115_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	115	0	1	01	01	H5253_115_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	115	0	1	01	01	H5253_115_0	3	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												
H5262	001	0	1	01	01	H5262_001_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	001	0	1	01	01	H5262_001_0	4	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	001	0	1	01	01	H5262_001_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	001	0	1	01	01	H5262_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				68.64	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	001	0	1	01	01	H5262_001_0	4	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, Vaccines												
H5262	001	0	1	01	01	H5262_001_0	4	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 Drug, Specialty Tier, Vaccines												
H5262	001	0	1	01	01	H5262_001_0	4	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 Drug, Specialty Tier, Vaccines										1		
H5262	003	0	1	01	01	H5262_003_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	003	0	1	01	01	H5262_003_0	4	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	003	0	1	01	01	H5262_003_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	003	0	1	01	01	H5262_003_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				87.98	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	003	0	1	01	01	H5262_003_0	4	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, Vaccines												
H5262	003	0	1	01	01	H5262_003_0	4	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 Drug, Specialty Tier, Vaccines												
H5262	003	0	1	01	01	H5262_003_0	4	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 Drug, Specialty Tier, Vaccines										1		
H5262	007	0	1	01	01	H5262_007_0	3	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	007	0	1	01	01	H5262_007_0	3	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	007	0	1	01	01	H5262_007_0	3	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	007	0	1	01	01	H5262_007_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				64.26	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	007	0	1	01	01	H5262_007_0	3	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, Vaccines												
H5262	007	0	1	01	01	H5262_007_0	3	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 Drug, Specialty Tier, Vaccines												
H5262	007	0	1	01	01	H5262_007_0	3	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 Drug, Specialty Tier, Vaccines										1		
H5262	008	0	1	01	01	H5262_008_0	3	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	008	0	1	01	01	H5262_008_0	3	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	008	0	1	01	01	H5262_008_0	3	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	008	0	1	01	01	H5262_008_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				77.05	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	008	0	1	01	01	H5262_008_0	3	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, Vaccines												
H5262	008	0	1	01	01	H5262_008_0	3	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 Drug, Specialty Tier, Vaccines												
H5262	008	0	1	01	01	H5262_008_0	3	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 Drug, Specialty Tier, Vaccines										1		
H5262	011	0	1	01	01	H5262_011_0	3	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	011	0	1	01	01	H5262_011_0	3	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, Vaccines												
H5262	011	0	1	01	01	H5262_011_0	3	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	011	0	1	01	01	H5262_011_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				87.70	35	35	35																				35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	011	0	1	01	01	H5262_011_0	3	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, Vaccines												
H5262	011	0	1	01	01	H5262_011_0	3	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 Drug, Specialty Tier, Vaccines												
H5262	011	0	1	01	01	H5262_011_0	3	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 Drug, Specialty Tier, Vaccines										1		
H5262	012	0	1	01	01	H5262_012_0	3	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	012	0	1	01	01	H5262_012_0	3	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, Vaccines												
H5262	012	0	1	01	01	H5262_012_0	3	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	012	0	1	01	01	H5262_012_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				96.79	35	35	35																				35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	012	0	1	01	01	H5262_012_0	3	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, Vaccines												
H5262	012	0	1	01	01	H5262_012_0	3	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 Drug, Specialty Tier, Vaccines												
H5262	012	0	1	01	01	H5262_012_0	3	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 Drug, Specialty Tier, Vaccines										1		
H5262	018	0	1	01	01	H5262_018_0	3	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	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												
H5262	018	0	1	01	01	H5262_018_0	3	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	018	0	1	01	01	H5262_018_0	3	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	018	0	1	01	01	H5262_018_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				84.27	30	30	30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	018	0	1	01	01	H5262_018_0	3	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, Vaccines												
H5262	018	0	1	01	01	H5262_018_0	3	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 Drug, Specialty Tier, Vaccines												
H5262	018	0	1	01	01	H5262_018_0	3	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 Drug, Specialty Tier, Vaccines										1		
H5262	019	0	1	01	01	H5262_019_0	3	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	019	0	1	01	01	H5262_019_0	3	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	019	0	1	01	01	H5262_019_0	3	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	019	0	1	01	01	H5262_019_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				88.56	30	30	30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	019	0	1	01	01	H5262_019_0	3	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, Vaccines												
H5262	019	0	1	01	01	H5262_019_0	3	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 Drug, Specialty Tier, Vaccines												
H5262	019	0	1	01	01	H5262_019_0	3	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 Drug, Specialty Tier, Vaccines										1		
H5262	021	0	1	01	01	H5262_021_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	021	0	1	01	01	H5262_021_0	4	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	021	0	1	01	01	H5262_021_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	021	0	1	01	01	H5262_021_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				95.49	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	021	0	1	01	01	H5262_021_0	4	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, Vaccines												
H5262	021	0	1	01	01	H5262_021_0	4	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 Drug, Specialty Tier, Vaccines												
H5262	021	0	1	01	01	H5262_021_0	4	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 Drug, Specialty Tier, Vaccines										1		
H5262	023	0	1	01	01	H5262_023_0	3	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	023	0	1	01	01	H5262_023_0	3	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	023	0	1	01	01	H5262_023_0	3	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	023	0	1	01	01	H5262_023_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				84.44	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	023	0	1	01	01	H5262_023_0	3	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, Vaccines												
H5262	023	0	1	01	01	H5262_023_0	3	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 Drug, Specialty Tier, Vaccines												
H5262	023	0	1	01	01	H5262_023_0	3	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 Drug, Specialty Tier, Vaccines										1		
H5262	024	0	1	01	01	H5262_024_0	3	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	024	0	1	01	01	H5262_024_0	3	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, Vaccines												
H5262	024	0	1	01	01	H5262_024_0	3	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	024	0	1	01	01	H5262_024_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				72.22	35	35	35																				35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	024	0	1	01	01	H5262_024_0	3	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, Vaccines												
H5262	024	0	1	01	01	H5262_024_0	3	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 Drug, Specialty Tier, Vaccines												
H5262	024	0	1	01	01	H5262_024_0	3	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 Drug, Specialty Tier, Vaccines										1		
H5262	026	0	1	01	01	H5262_026_0	3	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	026	0	1	01	01	H5262_026_0	3	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	026	0	1	01	01	H5262_026_0	3	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	026	0	1	01	01	H5262_026_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				64.15	30	30	30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	026	0	1	01	01	H5262_026_0	3	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, Vaccines												
H5262	026	0	1	01	01	H5262_026_0	3	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 Drug, Specialty Tier, Vaccines												
H5262	026	0	1	01	01	H5262_026_0	3	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 Drug, Specialty Tier, Vaccines										1		
H5273	001	0	1	01	01	H5273_001_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					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	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	001	0	1	01	01	H5273_001_0	6	Vaccines	4	11	1	2	6	1		111	01			1				30	60	90	1	2							30		31								0.00	0.00	0.00					0.00	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					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	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					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	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	002	0	1	01	01	H5273_002_0	7	Vaccines	4	11	1	2	6	1		111	01			1				30	60	90	1	2							30		31								0.00	0.00	0.00					0.00	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	2	Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5280	001	0	1	48	05	H5280_001_0	2	Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5280	001	0	1	48	05	H5280_001_0	2	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5294	010	0	1	01	01	H5294_010_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	010	0	1	01	01	H5294_010_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	010	0	1	01	01	H5294_010_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H5294	010	0	1	01	01	H5294_010_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				95.09	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	010	0	1	01	01	H5294_010_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	010	0	1	01	01	H5294_010_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	011	0	1	01	01	H5294_011_0	4	Preferred Generic	4	11	3	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	18.00				0.00	0.00	0.00				6.00				6.00			0.2	0.00		0.2	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	011	0	1	01	01	H5294_011_0	4	Preferred Generic	4	11	3	2	1	3		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	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, Select Care Drugs										1		3
H5294	011	0	1	01	01	H5294_011_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				17.00			0.57	0.4		0.57	0.4	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	011	0	1	01	01	H5294_011_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H5294	011	0	1	01	01	H5294_011_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5294	011	0	1	01	01	H5294_011_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	011	0	1	01	01	H5294_011_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	011	0	1	01	01	H5294_011_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5294	012	0	1	01	01	H5294_012_0	4	Preferred Generic	4	11	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, Select Care Drugs												
H5294	012	0	1	01	01	H5294_012_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				17.00			0.57	0.4		0.57	0.4	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	012	0	1	01	01	H5294_012_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H5294	012	0	1	01	01	H5294_012_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5294	012	0	1	01	01	H5294_012_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	012	0	1	01	01	H5294_012_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	013	0	1	01	01	H5294_013_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	013	0	1	01	01	H5294_013_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	013	0	1	01	01	H5294_013_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H5294	013	0	1	01	01	H5294_013_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.26	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	013	0	1	01	01	H5294_013_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	013	0	1	01	01	H5294_013_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	015	0	1	01	01	H5294_015_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	015	0	1	01	01	H5294_015_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	015	0	1	01	01	H5294_015_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	015	0	1	01	01	H5294_015_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.67	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	015	0	1	01	01	H5294_015_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	015	0	1	01	01	H5294_015_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	016	0	1	01	01	H5294_016_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	016	0	1	01	01	H5294_016_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	016	0	1	01	01	H5294_016_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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, Select Care Drugs												
H5294	016	0	1	01	01	H5294_016_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.26	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	016	0	1	01	01	H5294_016_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	016	0	1	01	01	H5294_016_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	017	0	1	01	01	H5294_017_0	4	Preferred Generic	4	11	3	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	18.00				0.00	0.00	0.00				6.00				6.00			0.2	0.00		0.2	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	017	0	1	01	01	H5294_017_0	4	Preferred Generic	4	11	3	2	1	3		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	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, Select Care Drugs										1		3
H5294	017	0	1	01	01	H5294_017_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				17.00			0.57	0.4		0.57	0.4	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	017	0	1	01	01	H5294_017_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5294	017	0	1	01	01	H5294_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5294	017	0	1	01	01	H5294_017_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	017	0	1	01	01	H5294_017_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	017	0	1	01	01	H5294_017_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5294	018	0	1	01	01	H5294_018_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	018	0	1	01	01	H5294_018_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5294	018	0	1	01	01	H5294_018_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					14.00	28.00	42.00											19.00	38.00	57.00				14.00	28.00	0.00				19.00				19.00			0.63	0.47		0.63	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H5294	018	0	1	01	01	H5294_018_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5294	018	0	1	01	01	H5294_018_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	018	0	1	01	01	H5294_018_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	018	0	1	01	01	H5294_018_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5294	019	0	1	01	01	H5294_019_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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, Select Care Drugs												
H5294	019	0	1	01	01	H5294_019_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				17.00			0.57	0.4		0.57	0.4	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	019	0	1	01	01	H5294_019_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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												
H5294	019	0	1	01	01	H5294_019_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5294	019	0	1	01	01	H5294_019_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	019	0	1	01	01	H5294_019_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	001	0	1	01	01	H5296_001_0	5	Preferred Generic	4	11	1	2	1	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	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	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	001	0	1	01	01	H5296_001_0	5	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	001	0	1	01	01	H5296_001_0	5	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	279.00																	93.00			93.00		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	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				930.00	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	5	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	5	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5296	003	0	1	02	01	H5296_003_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	003	0	1	02	01	H5296_003_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	003	0	1	02	01	H5296_003_0	5	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	003	0	1	02	01	H5296_003_0	5	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	279.00																	93.00			93.00		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	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				936.00	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	5	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	5	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5296	004	0	1	01	01	H5296_004_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	004	0	1	01	01	H5296_004_0	5	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																			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												
H5296	004	0	1	01	01	H5296_004_0	5	Preferred Brand	4	11	3	1	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31				86.00	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	004	0	1	01	01	H5296_004_0	5	Non-Preferred Drug	4	11	3	1	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31				84.00	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	004	0	1	01	01	H5296_004_0	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				669.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	004	0	1	01	01	H5296_004_0	5	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5302	012	0	1	01	01	H5302_012_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5302	012	0	1	01	01	H5302_012_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5302	012	0	1	01	01	H5302_012_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	012	0	1	01	01	H5302_012_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											45.43	25	25	25				38.75	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	012	0	1	01	01	H5302_012_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											593.15	25						388.57	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	013	0	1	01	01	H5302_013_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5302	013	0	1	01	01	H5302_013_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5302	013	0	1	01	01	H5302_013_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	013	0	1	01	01	H5302_013_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											54.29	30	30	30				50.88	30	30	30										30	30	30				30	30	30				30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	013	0	1	01	01	H5302_013_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											607.57	25						390.20	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	014	0	1	01	01	H5302_014_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5302	014	0	1	01	01	H5302_014_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5302	014	0	1	01	01	H5302_014_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	014	0	1	01	01	H5302_014_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											43.05	25	25	25				41.27	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	014	0	1	01	01	H5302_014_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											606.26	25						394.25	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	018	0	1	01	01	H5302_018_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5302	018	0	1	01	01	H5302_018_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	018	0	1	01	01	H5302_018_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5302	018	0	1	01	01	H5302_018_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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		
H5302	018	0	1	01	01	H5302_018_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	018	0	1	01	01	H5302_018_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	018	0	1	01	01	H5302_018_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											957.07	33						456.80	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	019	0	1	01	01	H5302_019_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5302	019	0	1	01	01	H5302_019_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	019	0	1	01	01	H5302_019_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5302	019	0	1	01	01	H5302_019_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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		
H5302	019	0	1	01	01	H5302_019_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	019	0	1	01	01	H5302_019_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	019	0	1	01	01	H5302_019_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											957.07	33						456.80	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	001	0	1	01	01	H5325_001_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5325	001	0	1	01	01	H5325_001_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5325	001	0	1	01	01	H5325_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	001	0	1	01	01	H5325_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											41.41	25	25	25				39.41	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	001	0	1	01	01	H5325_001_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											551.27	26						366.33	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	002	0	1	01	01	H5325_002_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5325	002	0	1	01	01	H5325_002_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5325	002	0	1	01	01	H5325_002_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	002	0	1	01	01	H5325_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											42.90	25	25	25				41.79	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	002	0	1	01	01	H5325_002_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											554.89	25						350.93	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	003	0	1	01	01	H5325_003_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5325	003	0	1	01	01	H5325_003_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5325	003	0	1	01	01	H5325_003_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	003	0	1	01	01	H5325_003_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											40.78	25	25	25				39.48	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	003	0	1	01	01	H5325_003_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											592.54	26						388.36	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	004	0	1	01	01	H5325_004_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5325	004	0	1	01	01	H5325_004_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5325	004	0	1	01	01	H5325_004_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	004	0	1	01	01	H5325_004_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											40.35	25	25	25				38.06	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	004	0	1	01	01	H5325_004_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											605.92	26						400.48	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	005	0	1	01	01	H5325_005_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5325	005	0	1	01	01	H5325_005_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5325	005	0	1	01	01	H5325_005_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	005	0	1	01	01	H5325_005_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											41.57	25	25	25				39.45	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	005	0	1	01	01	H5325_005_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											617.27	26						404.89	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	006	0	1	01	01	H5325_006_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								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												
H5325	006	0	1	01	01	H5325_006_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5325	006	0	1	01	01	H5325_006_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	006	0	1	01	01	H5325_006_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											42.94	25	25	25				40.26	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	006	0	1	01	01	H5325_006_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											588.02	25						381.63	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	007	0	1	01	01	H5325_007_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5325	007	0	1	01	01	H5325_007_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5325	007	0	1	01	01	H5325_007_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	007	0	1	01	01	H5325_007_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											43.31	25	25	25				40.41	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	007	0	1	01	01	H5325_007_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											584.20	25						379.60	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	008	0	1	01	01	H5325_008_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								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												
H5325	008	0	1	01	01	H5325_008_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5325	008	0	1	01	01	H5325_008_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	008	0	1	01	01	H5325_008_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											42.87	25	25	25				40.19	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	008	0	1	01	01	H5325_008_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											587.84	25						381.44	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	009	0	1	01	01	H5325_009_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5325	009	0	1	01	01	H5325_009_0	6	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5325	009	0	1	01	01	H5325_009_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	009	0	1	01	01	H5325_009_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											41.99	25	25	25				40.26	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	009	0	1	01	01	H5325_009_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											594.79	25						389.63	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	5	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5373	001	0	1	01	01	H5373_001_0	5	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5373	001	0	1	01	01	H5373_001_0	5	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		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	5	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												
H5373	001	0	1	01	01	H5373_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		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	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1486.27	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5386	003	0	1	01	01	H5386_003_0	2	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	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, Select Care Drugs												
H5386	003	0	1	01	01	H5386_003_0	2	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	8.00	16.00	24.00																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	003	0	1	01	01	H5386_003_0	2	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	40.00	80.00	120.00																			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												
H5386	003	0	1	01	01	H5386_003_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	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												
H5386	003	0	1	01	01	H5386_003_0	2	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34				763.51	33																				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	2	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	4	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	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, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	4	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	8.00	16.00	24.00																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	40.00	80.00	120.00																			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												
H5386	004	0	1	01	01	H5386_004_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		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												
H5386	004	0	1	01	01	H5386_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34				795.69	33																				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	4	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	005	0	1	01	01	H5386_005_0	2	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	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, Select Care Drugs												
H5386	005	0	1	01	01	H5386_005_0	2	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	8.00	16.00	24.00																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	005	0	1	01	01	H5386_005_0	2	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	40.00	80.00	120.00																			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												
H5386	005	0	1	01	01	H5386_005_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	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												
H5386	005	0	1	01	01	H5386_005_0	2	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34				763.51	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	005	0	1	01	01	H5386_005_0	2	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	001	0	1	01	01	H5398_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	001	0	1	01	01	H5398_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	0.00				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	001	0	1	01	01	H5398_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H5398	001	0	1	01	01	H5398_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5398	001	0	1	01	01	H5398_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	001	0	1	01	01	H5398_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	002	0	1	01	01	H5398_002_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5398	002	0	1	01	01	H5398_002_0	4	Generic	4	11	1	2	2	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	18.00				0.00	0.00	0.00				6.00				6.00			0.2	0.00		0.2	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	002	0	1	01	01	H5398_002_0	4	Generic	4	11	1	2	2	3		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	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, Select Care Drugs										1		
H5398	002	0	1	01	01	H5398_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H5398	002	0	1	01	01	H5398_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5398	002	0	1	01	01	H5398_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	002	0	1	01	01	H5398_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5410	001	0	1	01	01	H5410_001_0	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	4	1		010	01			1				30											30		31											1024.88	33						617.76	33																							33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	01	01	H5410_018_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	01	01	H5410_018_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	01	01	H5410_018_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											862.60	33						776.20	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	024	0	1	01	01	H5410_024_0	6	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	6	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	024	0	1	01	01	H5410_024_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	024	0	1	01	01	H5410_024_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											987.10	33						779.48	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	025	0	1	01	01	H5410_025_0	5	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	025	0	1	01	01	H5410_025_0	5	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					13.00	26.00	26.00											20.00	40.00	60.00				13.00	26.00	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												
H5410	025	0	1	01	01	H5410_025_0	5	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											46.88	19	19	19				40.42	18	18	18										19	19	19				18	18	18			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	025	0	1	01	01	H5410_025_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											81.65	44	44	44				76.00	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	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											513.67	25						404.55	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	026	0	1	01	01	H5410_026_0	4	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	026	0	1	01	01	H5410_026_0	4	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	026	0	1	01	01	H5410_026_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	026	0	1	01	01	H5410_026_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	026	0	1	01	01	H5410_026_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											947.04	33						648.87	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	027	0	1	01	01	H5410_027_0	5	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	027	0	1	01	01	H5410_027_0	5	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	027	0	1	01	01	H5410_027_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	027	0	1	01	01	H5410_027_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											961.44	33						627.63	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	028	0	1	01	01	H5410_028_0	4	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	028	0	1	01	01	H5410_028_0	4	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	028	0	1	01	01	H5410_028_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	028	0	1	01	01	H5410_028_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	028	0	1	01	01	H5410_028_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											790.40	33						729.66	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	029	0	1	01	01	H5410_029_0	6	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	6	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	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	029	0	1	01	01	H5410_029_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											922.46	33						744.55	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	030	0	1	01	01	H5410_030_0	5	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	5	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	030	0	1	01	01	H5410_030_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	030	0	1	01	01	H5410_030_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											795.73	33						621.93	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	031	0	1	01	01	H5410_031_0	6	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					1.00	2.00	2.00											18.00	36.00	54.00				0.00	0.00	0.00				18.00				18.00			0.60	0.03		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	6	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					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												
H5410	031	0	1	01	01	H5410_031_0	6	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											40.51	19	19	19				36.29	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	6	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											70.23	41	41	41				65.38	41	41	41										41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	031	0	1	01	01	H5410_031_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											445.65	25						343.77	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	032	0	1	01	01	H5410_032_0	6	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					1.00	2.00	2.00											18.00	36.00	54.00				0.00	0.00	0.00				18.00				18.00			0.60	0.03		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	6	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					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												
H5410	032	0	1	01	01	H5410_032_0	6	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											42.58	19	19	19				38.02	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	6	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											74.78	41	41	41				69.21	41	41	41										41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	032	0	1	01	01	H5410_032_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											468.30	25						366.99	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	033	0	1	01	01	H5410_033_0	4	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					1.00	2.00	2.00											18.00	36.00	54.00				0.00	0.00	0.00				18.00				18.00			0.60	0.03		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	4	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					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												
H5410	033	0	1	01	01	H5410_033_0	4	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											34.36	19	19	19				30.83	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	4	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											58.25	41	41	41				54.51	41	41	41										41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	033	0	1	01	01	H5410_033_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											385.81	25						301.87	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	034	0	1	01	01	H5410_034_0	4	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					1.00	2.00	2.00											18.00	36.00	54.00				0.00	0.00	0.00				18.00				18.00			0.60	0.03		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	4	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					11.00	22.00	22.00											20.00	40.00	60.00				11.00	22.00	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												
H5410	034	0	1	01	01	H5410_034_0	4	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											27.41	19	19	19				24.73	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	4	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											45.91	41	41	41				42.56	41	41	41										41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	034	0	1	01	01	H5410_034_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											308.97	25						230.81	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	035	0	1	01	01	H5410_035_0	4	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					1.00	2.00	2.00											18.00	36.00	54.00				0.00	0.00	0.00				18.00				18.00			0.60	0.03		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	4	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					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												
H5410	035	0	1	01	01	H5410_035_0	4	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											37.64	19	19	19				33.79	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	4	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											64.12	41	41	41				60.34	41	41	41										41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	035	0	1	01	01	H5410_035_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											415.16	25						320.97	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	037	0	1	01	01	H5410_037_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	037	0	1	01	01	H5410_037_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5410	037	0	1	01	01	H5410_037_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	037	0	1	01	01	H5410_037_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5410	037	0	1	01	01	H5410_037_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	037	0	1	01	01	H5410_037_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	037	0	1	01	01	H5410_037_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											876.13	33						681.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	039	0	1	01	01	H5410_039_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	039	0	1	01	01	H5410_039_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5410	039	0	1	01	01	H5410_039_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	039	0	1	01	01	H5410_039_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5410	039	0	1	01	01	H5410_039_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	039	0	1	01	01	H5410_039_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	039	0	1	01	01	H5410_039_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											876.13	33						681.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	040	0	1	01	01	H5410_040_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	040	0	1	01	01	H5410_040_0	4	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					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		
H5410	040	0	1	01	01	H5410_040_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	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	040	0	1	01	01	H5410_040_0	4	Generic	4	01	1	2	2	3		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										1		
H5410	040	0	1	01	01	H5410_040_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	040	0	1	01	01	H5410_040_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	040	0	1	01	01	H5410_040_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											876.13	33						681.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	041	0	1	01	01	H5410_041_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					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	041	0	1	01	01	H5410_041_0	5	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					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		
H5410	041	0	1	01	01	H5410_041_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					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	041	0	1	01	01	H5410_041_0	5	Generic	4	01	1	2	2	3		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										1		
H5410	041	0	1	01	01	H5410_041_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	041	0	1	01	01	H5410_041_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	041	0	1	01	01	H5410_041_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											876.13	33						681.65	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	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	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	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	20.00		60.00																											60.00						50.00				20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				303.00	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	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	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	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	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	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	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	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												
H5420	006	0	1	01	01	H5420_006_0	3	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	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	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	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	Preferred Brand	4	11	1	1	3	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												
H5420	006	0	1	01	01	H5420_006_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				2	2			100				30		31				51.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				252.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5422	007	0	1	01	01	H5422_007_0	6	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					10.00	20.00	30.00					10.00	30.00	30.00																10.00				10.00			0.33	0.33	0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	6	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												
H5422	007	0	1	01	01	H5422_007_0	6	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	007	0	1	01	01	H5422_007_0	6	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	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	Select Care Drugs	4	01	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	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	008	0	1	01	01	H5422_008_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	6	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			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	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	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	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	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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												
H5422	011	0	1	01	01	H5422_011_0	7	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					0.00	0.00	0.00																16.00				16.00			0.53	0.37	0.00			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	011	0	1	01	01	H5422_011_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	011	0	1	01	01	H5422_011_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H5422	011	0	1	01	01	H5422_011_0	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	011	0	1	01	01	H5422_011_0	7	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	7	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	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	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	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					0.00	0.00	0.00																10.00				10.00			0.33	0.33	0.00			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	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	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	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	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	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	015	0	1	01	01	H5422_015_0	9	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					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												
H5422	015	0	1	01	01	H5422_015_0	9	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	015	0	1	01	01	H5422_015_0	9	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												
H5422	015	0	1	01	01	H5422_015_0	9	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	015	0	1	01	01	H5422_015_0	9	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												
H5422	015	0	1	01	01	H5422_015_0	9	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	015	0	1	01	01	H5422_015_0	9	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	016	0	1	01	01	H5422_016_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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	016	0	1	01	01	H5422_016_0	7	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												
H5422	016	0	1	01	01	H5422_016_0	7	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	016	0	1	01	01	H5422_016_0	7	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	016	0	1	01	01	H5422_016_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	016	0	1	01	01	H5422_016_0	7	Select Care Drugs	4	01	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	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	017	0	1	01	01	H5422_017_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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												
H5422	017	0	1	01	01	H5422_017_0	7	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					0.00	0.00	0.00																16.00				16.00			0.53	0.37	0.00			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	017	0	1	01	01	H5422_017_0	7	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	017	0	1	01	01	H5422_017_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	017	0	1	01	01	H5422_017_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	017	0	1	01	01	H5422_017_0	7	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	017	0	1	01	01	H5422_017_0	7	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	5	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					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												
H5425	001	0	1	01	01	H5425_001_0	5	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					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		3
H5425	001	0	1	01	01	H5425_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	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												
H5425	001	0	1	01	01	H5425_001_0	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	004	0	1	01	01	H5425_004_0	5	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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	005	0	1	01	01	H5425_005_0	5	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	5	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	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	006	0	1	01	01	H5425_006_0	6	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	6	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	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	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												
H5425	006	0	1	01	01	H5425_006_0	6	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					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		
H5425	006	0	1	01	01	H5425_006_0	6	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					30.00	60.00	70.00											47.00	94.00	121.00				30.00	60.00	70.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	006	0	1	01	01	H5425_006_0	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	007	0	1	01	01	H5425_007_0	5	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	5	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	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	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												
H5425	007	0	1	01	01	H5425_007_0	5	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					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		
H5425	007	0	1	01	01	H5425_007_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					30.00	60.00	70.00											47.00	94.00	121.00				30.00	60.00	70.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	007	0	1	01	01	H5425_007_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	008	0	1	01	01	H5425_008_0	5	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	5	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	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	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												
H5425	008	0	1	01	01	H5425_008_0	5	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					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		
H5425	008	0	1	01	01	H5425_008_0	5	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					30.00	60.00	70.00											47.00	94.00	121.00				30.00	60.00	70.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	008	0	1	01	01	H5425_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	009	0	1	01	01	H5425_009_0	5	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	5	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	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	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												
H5425	009	0	1	01	01	H5425_009_0	5	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					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		
H5425	009	0	1	01	01	H5425_009_0	5	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					30.00	60.00	70.00											47.00	94.00	121.00				30.00	60.00	70.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	009	0	1	01	01	H5425_009_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	010	0	1	01	01	H5425_010_0	5	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	5	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	5	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											6.79	25	25	25				6.79	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	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											84.77	25	25	25				84.77	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											69.69	25	25	25				69.69	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	019	0	1	01	01	H5425_019_0	5	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					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												
H5425	019	0	1	01	01	H5425_019_0	5	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					0.00	0.00	0.00											12.00	24.00	24.00				0.00	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												
H5425	019	0	1	01	01	H5425_019_0	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	020	0	1	01	01	H5425_020_0	5	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					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												
H5425	020	0	1	01	01	H5425_020_0	5	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					0.00	0.00	0.00											12.00	24.00	24.00				0.00	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												
H5425	020	0	1	01	01	H5425_020_0	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	028	0	1	01	01	H5425_028_0	5	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	5	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	5	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					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	028	0	1	01	01	H5425_028_0	5	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					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		
H5425	028	0	1	01	01	H5425_028_0	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	030	0	1	01	01	H5425_030_0	5	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								2.00	4.00	6.00					0.00	0.00	0.00											2.00	4.00	6.00				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												
H5425	030	0	1	01	01	H5425_030_0	5	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								2.00	4.00	6.00					0.00	0.00	0.00											2.00	4.00	6.00				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										1		
H5425	030	0	1	01	01	H5425_030_0	5	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											6.81	25	25	25				6.81	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	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											69.68	25	25	25				69.68	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											46.51	25	25	25				46.51	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	033	0	1	01	01	H5425_033_0	5	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	5	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	5	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					0.00	0.00	0.00											14.00	28.00	28.00				0.00	0.00	0.00				14.00				14.00			0.47	0.00		0.47	0.00	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	033	0	1	01	01	H5425_033_0	5	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								14.00	28.00	28.00					0.00	0.00	0.00											14.00	28.00	28.00				0.00	0.00	0.00				14.00				14.00			0.47	0.00		0.47	0.00	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	033	0	1	01	01	H5425_033_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	034	0	1	01	01	H5425_034_0	5	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	5	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	5	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					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	034	0	1	01	01	H5425_034_0	5	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					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		
H5425	034	0	1	01	01	H5425_034_0	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	040	0	1	01	01	H5425_040_0	5	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	040	0	1	01	01	H5425_040_0	5	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											7.05	25	25	25				7.05	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	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											80.77	25	25	25				80.77	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											70.74	25	25	25				70.74	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	045	0	1	01	01	H5425_045_0	5	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	5	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											7.01	25	25	25				7.01	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	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											80.55	25	25	25				80.55	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											73.98	25	25	25				73.98	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	052	0	1	01	01	H5425_052_0	5	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	5	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					0.00	0.00	0.00											17.00	34.00	34.00				0.00	0.00	0.00				17.00				17.00			0.57	0.00		0.57	0.00	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	052	0	1	01	01	H5425_052_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	053	0	1	01	01	H5425_053_0	5	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	5	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	5	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					0.00	0.00	0.00											17.00	34.00	34.00				0.00	0.00	0.00				17.00				17.00			0.57	0.00		0.57	0.00	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	053	0	1	01	01	H5425_053_0	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	054	0	1	01	01	H5425_054_0	5	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	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	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					0.00	0.00	0.00											17.00	34.00	34.00				0.00	0.00	0.00				17.00				17.00			0.57	0.00		0.57	0.00	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	054	0	1	01	01	H5425_054_0	5	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	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	Specialty Tier	4	11	1	1	5	1		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	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	065	0	1	01	01	H5425_065_0	5	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	5	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	5	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					0.00	0.00	0.00											12.00	24.00	24.00				0.00	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												
H5425	065	0	1	01	01	H5425_065_0	5	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					0.00	0.00	0.00											12.00	24.00	24.00				0.00	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										1		
H5425	065	0	1	01	01	H5425_065_0	5	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					30.00	60.00	70.00											47.00	94.00	121.00				30.00	60.00	70.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	065	0	1	01	01	H5425_065_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	066	0	1	01	01	H5425_066_0	5	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	5	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	5	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					0.00	0.00	0.00											12.00	24.00	24.00				0.00	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												
H5425	066	0	1	01	01	H5425_066_0	5	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					0.00	0.00	0.00											12.00	24.00	24.00				0.00	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										1		
H5425	066	0	1	01	01	H5425_066_0	5	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					30.00	60.00	70.00											47.00	94.00	121.00				30.00	60.00	70.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	066	0	1	01	01	H5425_066_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	5	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	5	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	5	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					0.00	0.00	0.00											14.00	28.00	28.00				0.00	0.00	0.00				14.00				14.00			0.47	0.00		0.47	0.00	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	5	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					0.00	0.00	0.00											14.00	28.00	28.00				0.00	0.00	0.00				14.00				14.00			0.47	0.00		0.47	0.00	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	067	0	1	01	01	H5425_067_0	5	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					30.00	60.00	70.00											47.00	94.00	121.00				30.00	60.00	70.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	068	0	1	01	01	H5425_068_0	5	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	5	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	5	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					0.00	0.00	0.00											14.00	28.00	28.00				0.00	0.00	0.00				14.00				14.00			0.47	0.00		0.47	0.00	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	068	0	1	01	01	H5425_068_0	5	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					0.00	0.00	0.00											14.00	28.00	28.00				0.00	0.00	0.00				14.00				14.00			0.47	0.00		0.47	0.00	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	068	0	1	01	01	H5425_068_0	5	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					30.00	60.00	70.00											47.00	94.00	121.00				30.00	60.00	70.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	068	0	1	01	01	H5425_068_0	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	069	0	1	01	01	H5425_069_0	5	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	5	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	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	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												
H5425	069	0	1	01	01	H5425_069_0	5	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					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		
H5425	069	0	1	01	01	H5425_069_0	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	070	0	1	01	01	H5425_070_0	5	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	5	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	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	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												
H5425	070	0	1	01	01	H5425_070_0	5	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					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		
H5425	070	0	1	01	01	H5425_070_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								45.00	90.00	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	071	0	1	01	01	H5425_071_0	5	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	5	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											7.03	25	25	25				7.03	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	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											80.65	25	25	25				80.65	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											74.41	25	25	25				74.41	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	072	0	1	01	01	H5425_072_0	6	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	6	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											6.92	25	25	25				6.92	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	6	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											81.11	25	25	25				81.11	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	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											71.44	25	25	25				71.44	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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	073	0	1	01	01	H5425_073_0	5	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					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												
H5425	073	0	1	01	01	H5425_073_0	5	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					0.00	0.00	0.00											17.50	35.00	35.00				0.00	0.00	0.00				17.50				17.50			0.58	0.00		0.58	0.00	0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	073	0	1	01	01	H5425_073_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								45.00	90.00	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	074	0	1	01	01	H5425_074_0	5	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					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												
H5425	074	0	1	01	01	H5425_074_0	5	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					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												
H5425	074	0	1	01	01	H5425_074_0	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	075	0	1	01	01	H5425_075_0	5	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	075	0	1	01	01	H5425_075_0	5	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	075	0	1	01	01	H5425_075_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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												
H5425	075	0	1	01	01	H5425_075_0	5	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	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		
H5425	075	0	1	01	01	H5425_075_0	5	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	075	0	1	01	01	H5425_075_0	5	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	075	0	1	01	01	H5425_075_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	076	0	1	01	01	H5425_076_0	5	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	076	0	1	01	01	H5425_076_0	5	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	076	0	1	01	01	H5425_076_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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												
H5425	076	0	1	01	01	H5425_076_0	5	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	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		
H5425	076	0	1	01	01	H5425_076_0	5	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	076	0	1	01	01	H5425_076_0	5	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	076	0	1	01	01	H5425_076_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	077	0	1	01	01	H5425_077_0	5	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	077	0	1	01	01	H5425_077_0	5	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	077	0	1	01	01	H5425_077_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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												
H5425	077	0	1	01	01	H5425_077_0	5	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	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		
H5425	077	0	1	01	01	H5425_077_0	5	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	077	0	1	01	01	H5425_077_0	5	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	077	0	1	01	01	H5425_077_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	078	0	1	01	01	H5425_078_0	5	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	078	0	1	01	01	H5425_078_0	5	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	078	0	1	01	01	H5425_078_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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												
H5425	078	0	1	01	01	H5425_078_0	5	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	078	0	1	01	01	H5425_078_0	5	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	078	0	1	01	01	H5425_078_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	079	0	1	01	01	H5425_079_0	5	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	079	0	1	01	01	H5425_079_0	5	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	079	0	1	01	01	H5425_079_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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												
H5425	079	0	1	01	01	H5425_079_0	5	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	079	0	1	01	01	H5425_079_0	5	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	079	0	1	01	01	H5425_079_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	080	0	1	01	01	H5425_080_0	5	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	080	0	1	01	01	H5425_080_0	5	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	080	0	1	01	01	H5425_080_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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												
H5425	080	0	1	01	01	H5425_080_0	5	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	080	0	1	01	01	H5425_080_0	5	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	080	0	1	01	01	H5425_080_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	082	0	1	01	01	H5425_082_0	5	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	082	0	1	01	01	H5425_082_0	5	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	082	0	1	01	01	H5425_082_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	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												
H5425	082	0	1	01	01	H5425_082_0	5	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					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		
H5425	082	0	1	01	01	H5425_082_0	5	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					30.00	60.00	70.00											47.00	94.00	121.00				30.00	60.00	70.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	082	0	1	01	01	H5425_082_0	5	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	082	0	1	01	01	H5425_082_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	083	0	1	01	01	H5425_083_0	5	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					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												
H5425	083	0	1	01	01	H5425_083_0	5	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					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		3
H5425	083	0	1	01	01	H5425_083_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	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												
H5425	083	0	1	01	01	H5425_083_0	5	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	083	0	1	01	01	H5425_083_0	5	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	083	0	1	01	01	H5425_083_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	084	0	1	01	01	H5425_084_0	5	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	084	0	1	01	01	H5425_084_0	5	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	084	0	1	01	01	H5425_084_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	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												
H5425	084	0	1	01	01	H5425_084_0	5	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					30.00	60.00	70.00											47.00	94.00	121.00				30.00	60.00	70.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	084	0	1	01	01	H5425_084_0	5	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	084	0	1	01	01	H5425_084_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	085	0	1	01	01	H5425_085_0	5	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	085	0	1	01	01	H5425_085_0	5	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	085	0	1	01	01	H5425_085_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	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												
H5425	085	0	1	01	01	H5425_085_0	5	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					30.00	60.00	70.00											47.00	94.00	121.00				30.00	60.00	70.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	085	0	1	01	01	H5425_085_0	5	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	085	0	1	01	01	H5425_085_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	086	0	1	01	01	H5425_086_0	5	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	086	0	1	01	01	H5425_086_0	5	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	086	0	1	01	01	H5425_086_0	5	Generic	4	11	1	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	086	0	1	01	01	H5425_086_0	5	Generic	4	11	1	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	086	0	1	01	01	H5425_086_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								37.00	74.00	91.00					37.00	74.00	91.00											37.00	74.00	91.00				37.00	74.00	91.00				37.00				37.00			1.23	1.23		1.23	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	086	0	1	01	01	H5425_086_0	5	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					99.00	198.00	277.00											100.00	200.00	280.00				99.00	198.00	277.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	086	0	1	01	01	H5425_086_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	087	0	1	01	01	H5425_087_0	5	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	087	0	1	01	01	H5425_087_0	5	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	087	0	1	01	01	H5425_087_0	5	Generic	4	11	1	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	087	0	1	01	01	H5425_087_0	5	Generic	4	11	1	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	087	0	1	01	01	H5425_087_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								37.00	74.00	91.00					37.00	74.00	91.00											37.00	74.00	91.00				37.00	74.00	91.00				37.00				37.00			1.23	1.23		1.23	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	087	0	1	01	01	H5425_087_0	5	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					99.00	198.00	277.00											100.00	200.00	280.00				99.00	198.00	277.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	087	0	1	01	01	H5425_087_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	8	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	8	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	8	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	8	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	8	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	7	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	7	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	7	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	7	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	7	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	7	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	7	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	7	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	25.00		75.00																			25.00		50.00																25.00				25.00		0.83			0.83			0.74	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	7	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, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	10.00		30.00																			10.00		30.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	078	0	1	01	01	H5427_078_0	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	8	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	10.00		30.00																			10.00		30.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	8	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		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	8	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	8	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	8	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	8	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	8	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	088	0	1	01	01	H5427_088_0	8	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	75.00		225.00																			75.00		150.00																75.00				75.00		2.50			2.50			2.21	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	8	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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												
H5427	092	0	1	01	01	H5427_092_0	7	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	55.00		165.00																			55.00		110.00																55.00				55.00		1.83			1.83			1.62	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	7	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	9	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	9	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	9	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	9	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	9	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	8	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	8	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	8	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	25.00		75.00																			25.00		50.00																25.00				25.00		0.83			0.83			0.74	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	8	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	8	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	099	0	1	01	01	H5427_099_0	7	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	099	0	1	01	01	H5427_099_0	7	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	7	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	8	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	8	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	8	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	8	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	7	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	7	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	7	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	7	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	104	0	1	01	01	H5427_104_0	7	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	104	0	1	01	01	H5427_104_0	7	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	104	0	1	01	01	H5427_104_0	7	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	104	0	1	01	01	H5427_104_0	7	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	104	0	1	01	01	H5427_104_0	7	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	105	0	1	01	01	H5427_105_0	7	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	105	0	1	01	01	H5427_105_0	7	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	105	0	1	01	01	H5427_105_0	7	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	105	0	1	01	01	H5427_105_0	7	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	106	0	1	01	01	H5427_106_0	8	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	106	0	1	01	01	H5427_106_0	8	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	106	0	1	01	01	H5427_106_0	8	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	106	0	1	01	01	H5427_106_0	8	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	107	0	1	01	01	H5427_107_0	8	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	107	0	1	01	01	H5427_107_0	8	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	107	0	1	01	01	H5427_107_0	8	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	107	0	1	01	01	H5427_107_0	8	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	108	0	1	01	01	H5427_108_0	7	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	108	0	1	01	01	H5427_108_0	7	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	108	0	1	01	01	H5427_108_0	7	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	108	0	1	01	01	H5427_108_0	7	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	108	0	1	01	01	H5427_108_0	7	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	108	0	1	01	01	H5427_108_0	7	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												
H5431	001	0	1	01	01	H5431_001_0	7	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	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	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	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	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	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	Specialty Tier	4	11	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	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	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				2.14	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	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				9.23	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	Preferred Brand	4	10	1	1	3	1	010		01	010		1	30								30						30		34				80.30	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	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				52.05	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	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	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	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	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	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	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	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	012	0	1	01	01	H5431_012_0	7	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	Specialty Tier	4	11	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	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	7	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	7	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	013	0	1	01	01	H5431_013_0	7	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	015	0	1	01	01	H5431_015_0	9	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				2.15	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	9	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				9.38	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	9	Preferred Brand	4	10	1	1	3	1	010		01	010		1	30								30						30		34				80.46	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	9	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				52.10	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	9	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	9	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	7	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				2.26	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	7	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				9.92	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	7	Preferred Brand	4	10	1	1	3	1	010		01	010		1	30								30						30		34				80.23	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	7	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				60.85	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	7	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	7	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	017	0	1	01	01	H5431_017_0	7	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	017	0	1	01	01	H5431_017_0	7	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	017	0	1	01	01	H5431_017_0	7	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	017	0	1	01	01	H5431_017_0	7	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	017	0	1	01	01	H5431_017_0	7	Preferred Brand	4	10	1	2	3	1		010	01	010		1				30					30						30		34								47.00							42.00							42.00																		47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	017	0	1	01	01	H5431_017_0	7	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, Supplemental Drugs												
H5431	017	0	1	01	01	H5431_017_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	017	0	1	01	01	H5431_017_0	7	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	018	0	1	01	01	H5431_018_0	7	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	018	0	1	01	01	H5431_018_0	7	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	018	0	1	01	01	H5431_018_0	7	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	018	0	1	01	01	H5431_018_0	7	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	018	0	1	01	01	H5431_018_0	7	Preferred Brand	4	10	1	2	3	1		010	01	010		1				30					30						30		34								47.00							42.00							42.00																		47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	018	0	1	01	01	H5431_018_0	7	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, Supplemental Drugs												
H5431	018	0	1	01	01	H5431_018_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	018	0	1	01	01	H5431_018_0	7	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	019	0	1	01	01	H5431_019_0	11	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				2.15	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	019	0	1	01	01	H5431_019_0	11	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				9.34	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	019	0	1	01	01	H5431_019_0	11	Preferred Brand	4	10	1	1	3	1	010		01	010		1	30								30						30		34				80.43	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	019	0	1	01	01	H5431_019_0	11	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				51.91	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	019	0	1	01	01	H5431_019_0	11	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	019	0	1	01	01	H5431_019_0	11	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	3	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	3	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	3	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1301.67	28						1301.67	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	002	0	1	04	01	H5434_002_0	6	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	6	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1377.96	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	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	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1397.99	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1430.70	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	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1425.77	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	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1487.45	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	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1409.49	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	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1516.79	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	6	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	6	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	6	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	033	0	1	04	01	H5434_033_0	6	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	033	0	1	04	01	H5434_033_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1377.50	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	6	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	6	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	6	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	034	0	1	04	01	H5434_034_0	6	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	034	0	1	04	01	H5434_034_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1405.92	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	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1381.42	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	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1381.21	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	6	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	6	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	039	0	1	04	01	H5434_039_0	6	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	039	0	1	04	01	H5434_039_0	6	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	039	0	1	04	01	H5434_039_0	6	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	039	0	1	04	01	H5434_039_0	6	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	039	0	1	04	01	H5434_039_0	6	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	039	0	1	04	01	H5434_039_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1391.50	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	039	0	1	04	01	H5434_039_0	6	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	039	0	1	04	01	H5434_039_0	6	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5435	024	0	1	09	04	H5435_024_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	2	Generic	4	01	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	2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				162.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5439	011	0	1	04	01	H5439_011_0	4	Preferred Generic	4	11	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											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, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H5439	011	0	1	04	01	H5439_011_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5439	015	0	1	04	01	H5439_015_0	3	Preferred Generic	4	11	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											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, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H5439	015	0	1	04	01	H5439_015_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_0	3	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	3	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5439	017	0	1	04	01	H5439_017_0	3	Preferred Generic	4	11	3	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	4.00	6.00				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, Select Care Drugs												
H5439	017	0	1	04	01	H5439_017_0	3	Preferred Generic	4	11	3	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	4.00	6.00				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, Select Care Drugs										1		3
H5439	017	0	1	04	01	H5439_017_0	3	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					8.00	16.00	24.00											15.00	30.00	45.00				8.00	16.00	0.00				15.00				15.00			0.5	0.27		0.5	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	017	0	1	04	01	H5439_017_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H5439	017	0	1	04	01	H5439_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5439	017	0	1	04	01	H5439_017_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	017	0	1	04	01	H5439_017_0	3	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	3	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5439	018	0	1	04	01	H5439_018_0	4	Preferred Generic	4	11	3	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	4.00	6.00				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, Select Care Drugs												
H5439	018	0	1	04	01	H5439_018_0	4	Preferred Generic	4	11	3	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	4.00	6.00				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, Select Care Drugs										1		3
H5439	018	0	1	04	01	H5439_018_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	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	Preferred Brand	4	11	1	2	3	1		111	01		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												
H5439	018	0	1	04	01	H5439_018_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5439	018	0	1	04	01	H5439_018_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	018	0	1	04	01	H5439_018_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	018	0	1	04	01	H5439_018_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5439	019	0	1	04	01	H5439_019_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	2.00	3.00					0.00	0.00	0.00											1.00	2.00	3.00				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												
H5439	019	0	1	04	01	H5439_019_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	2.00	3.00					0.00	0.00	0.00											1.00	2.00	3.00				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		3
H5439	019	0	1	04	01	H5439_019_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	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	Preferred Brand	4	11	1	2	3	1		111	01		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												
H5439	019	0	1	04	01	H5439_019_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5439	019	0	1	04	01	H5439_019_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	019	0	1	04	01	H5439_019_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	019	0	1	04	01	H5439_019_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5447	001	0	1	01	01	H5447_001_0	7	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	0.00	0.00	0.00																			0.00	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	7	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	7	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	7	Non-Preferred Brand	4	10	1	1	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				63.89	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	7	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							29	31				932.52	29																				29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	002	0	1	01	01	H5447_002_0	6	Preferred Generic	3	01	1	1	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				2.42	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	6	Generic	3	01	1	1	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				9.32	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	6	Preferred Brand	3	10	1	1	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				73.81	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	6	Non-Preferred Brand	3	10	1	1	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				50.62	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	6	Specialty Tier	3	11	1	1	5	1	010		10	010		1	30								30							29	31				658.37	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5454	001	0	1	01	01	H5454_001_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	001	0	1	01	01	H5454_001_0	5	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					12.00	24.00	36.00											19.00	38.00	57.00				12.00	24.00	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	5	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	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	5	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	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	5	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											958.36	33	33	33				958.36	33	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	4	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					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	002	0	1	01	01	H5454_002_0	4	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					12.00	24.00	36.00											19.00	38.00	57.00				12.00	24.00	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	4	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	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	4	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	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	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											958.99	33	33	33				958.99	33	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	6	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	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 Brand, Specialty Tier												
H5471	064	0	1	01	01	H5471_064_0	6	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	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 Brand, Specialty Tier												
H5471	064	0	1	01	01	H5471_064_0	6	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	6	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	064	0	1	01	01	H5471_064_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	065	0	1	01	01	H5471_065_0	7	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	7	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	7	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	7	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	7	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	7	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	7	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	6	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	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 Brand, Specialty Tier												
H5471	066	0	1	01	01	H5471_066_0	6	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	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 Brand, Specialty Tier												
H5471	066	0	1	01	01	H5471_066_0	6	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	6	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	066	0	1	01	01	H5471_066_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	6	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	6	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	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				59.15	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				117.66	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	8	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	8	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	8	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	8	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				68.65	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	8	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				124.66	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	069	0	1	01	01	H5471_069_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	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	6	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	6	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	6	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	6	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	6	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	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	10.00																					10.00																		10.00				10.00		0.33			0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	069	0	1	01	01	H5471_069_0	6	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	10.00																					10.00																		10.00				10.00		0.33			0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	069	0	1	01	01	H5471_069_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	070	0	1	01	01	H5471_070_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	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	6	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	6	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	6	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	071	0	1	01	01	H5471_071_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	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	6	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	6	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	6	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	6	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	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	55.00																					55.00																		55.00				55.00		1.83			1.83			1.62	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	071	0	1	01	01	H5471_071_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	072	0	1	01	01	H5471_072_0	6	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	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 Brand, Specialty Tier												
H5471	072	0	1	01	01	H5471_072_0	6	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	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 Brand, Specialty Tier												
H5471	072	0	1	01	01	H5471_072_0	6	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	6	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	072	0	1	01	01	H5471_072_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	073	0	1	01	01	H5471_073_0	6	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	6	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	6	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	6	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	6	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	6	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	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	073	0	1	01	01	H5471_073_0	6	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	073	0	1	01	01	H5471_073_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	074	0	1	01	01	H5471_074_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	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	6	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	6	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	6	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	6	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	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	074	0	1	01	01	H5471_074_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	075	0	1	01	01	H5471_075_0	8	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	8	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	8	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	8	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	8	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	30.00	60.00	90.00																			30.00	90.00	90.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	075	0	1	01	01	H5471_075_0	8	Preferred Brand	4	10	1	2	3	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	30.00	60.00	90.00																			30.00	90.00	90.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	075	0	1	01	01	H5471_075_0	8	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	8	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	8	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	6	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	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 Brand, Specialty Tier												
H5471	076	0	1	01	01	H5471_076_0	6	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	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 Brand, Specialty Tier												
H5471	076	0	1	01	01	H5471_076_0	6	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	6	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	076	0	1	01	01	H5471_076_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	077	0	1	01	01	H5471_077_0	6	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	6	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	6	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	6	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	6	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	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	077	0	1	01	01	H5471_077_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	078	0	1	01	01	H5471_078_0	6	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	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	6	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	6	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	6	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	6	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	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	078	0	1	01	01	H5471_078_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	080	0	1	01	01	H5471_080_0	6	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	6	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	6	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	6	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	6	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	6	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	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	080	0	1	01	01	H5471_080_0	6	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	080	0	1	01	01	H5471_080_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	082	0	1	01	01	H5471_082_0	6	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	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 Brand, Specialty Tier												
H5471	082	0	1	01	01	H5471_082_0	6	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	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 Brand, Specialty Tier												
H5471	082	0	1	01	01	H5471_082_0	6	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	6	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	082	0	1	01	01	H5471_082_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	083	0	1	01	01	H5471_083_0	6	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	6	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	6	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	6	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	6	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	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	083	0	1	01	01	H5471_083_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	084	0	1	01	01	H5471_084_0	6	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	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 Brand, Specialty Tier												
H5471	084	0	1	01	01	H5471_084_0	6	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	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 Brand, Specialty Tier												
H5471	084	0	1	01	01	H5471_084_0	6	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	6	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	084	0	1	01	01	H5471_084_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	085	0	1	01	01	H5471_085_0	6	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	6	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	6	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	6	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	6	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	6	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	6	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	085	0	1	01	01	H5471_085_0	6	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	085	0	1	01	01	H5471_085_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_0	6	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	6	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	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				58.11	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				112.62	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	6	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	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	6	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	6	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	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				58.57	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				110.95	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	103	0	1	01	01	H5471_103_0	6	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	6	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	6	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	103	0	1	01	01	H5471_103_0	6	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	103	0	1	01	01	H5471_103_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	104	0	1	01	01	H5471_104_0	6	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	104	0	1	01	01	H5471_104_0	6	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	104	0	1	01	01	H5471_104_0	6	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																			0.00	0.00	0.00																10.00				10.00		0.33			0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	104	0	1	01	01	H5471_104_0	6	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																			0.00	0.00	0.00																10.00				10.00		0.33			0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	104	0	1	01	01	H5471_104_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	105	0	1	01	01	H5471_105_0	6	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	105	0	1	01	01	H5471_105_0	6	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	105	0	1	01	01	H5471_105_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	15.00	30.00	45.00																			0.00	0.00	0.00																15.00				15.00		0.50			0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	105	0	1	01	01	H5471_105_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	15.00	30.00	45.00																			0.00	0.00	0.00																15.00				15.00		0.50			0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	105	0	1	01	01	H5471_105_0	6	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	6	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	6	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												
H5471	106	0	1	01	01	H5471_106_0	6	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																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	106	0	1	01	01	H5471_106_0	6	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																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	106	0	1	01	01	H5471_106_0	6	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																			0.00	0.00	0.00																20.00				20.00		0.67			0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	106	0	1	01	01	H5471_106_0	6	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																			0.00	0.00	0.00																20.00				20.00		0.67			0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	106	0	1	01	01	H5471_106_0	6	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	106	0	1	01	01	H5471_106_0	6	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	106	0	1	01	01	H5471_106_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	107	0	1	01	01	H5471_107_0	6	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	107	0	1	01	01	H5471_107_0	6	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	107	0	1	01	01	H5471_107_0	6	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																			0.00	0.00	0.00																10.00				10.00		0.33			0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	107	0	1	01	01	H5471_107_0	6	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																			0.00	0.00	0.00																10.00				10.00		0.33			0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	107	0	1	01	01	H5471_107_0	6	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	107	0	1	01	01	H5471_107_0	6	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	107	0	1	01	01	H5471_107_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	108	0	1	01	01	H5471_108_0	6	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	108	0	1	01	01	H5471_108_0	6	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	108	0	1	01	01	H5471_108_0	6	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																			0.00	0.00	0.00																10.00				10.00		0.33			0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	108	0	1	01	01	H5471_108_0	6	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																			0.00	0.00	0.00																10.00				10.00		0.33			0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	108	0	1	01	01	H5471_108_0	6	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	108	0	1	01	01	H5471_108_0	6	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	108	0	1	01	01	H5471_108_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	001	0	1	02	01	H5475_001_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	001	0	1	02	01	H5475_001_0	4	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	15.00				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												
H5475	001	0	1	02	01	H5475_001_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	36.00	72.00	108.00																									36.00	72.00	108.00				36.00	72.00	72.00				36.00				36.00		1.2				1.2	1.2	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	001	0	1	02	01	H5475_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				89.88	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	001	0	1	02	01	H5475_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	001	0	1	02	01	H5475_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	005	0	1	02	01	H5475_005_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	005	0	1	02	01	H5475_005_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					13.00	26.00	39.00											18.00	36.00	54.00				13.00	26.00	0.00				18.00				18.00			0.6	0.43		0.6	0.43	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	005	0	1	02	01	H5475_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5475	005	0	1	02	01	H5475_005_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.57	36	36	36				92.15	34	34	34										36	36	36				34	34	34			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	005	0	1	02	01	H5475_005_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	005	0	1	02	01	H5475_005_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	010	0	1	02	01	H5475_010_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	010	0	1	02	01	H5475_010_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	010	0	1	02	01	H5475_010_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	010	0	1	02	01	H5475_010_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.65	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	010	0	1	02	01	H5475_010_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	010	0	1	02	01	H5475_010_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	011	0	1	02	01	H5475_011_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	011	0	1	02	01	H5475_011_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H5475	011	0	1	02	01	H5475_011_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H5475	011	0	1	02	01	H5475_011_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5475	011	0	1	02	01	H5475_011_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	011	0	1	02	01	H5475_011_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	021	0	1	02	01	H5475_021_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	021	0	1	02	01	H5475_021_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	021	0	1	02	01	H5475_021_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H5475	021	0	1	02	01	H5475_021_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				96.62	45	45	45																								45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	021	0	1	02	01	H5475_021_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	021	0	1	02	01	H5475_021_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	022	0	1	02	01	H5475_022_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	022	0	1	02	01	H5475_022_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H5475	022	0	1	02	01	H5475_022_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H5475	022	0	1	02	01	H5475_022_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5475	022	0	1	02	01	H5475_022_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	022	0	1	02	01	H5475_022_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	024	0	1	02	01	H5475_024_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	024	0	1	02	01	H5475_024_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H5475	024	0	1	02	01	H5475_024_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H5475	024	0	1	02	01	H5475_024_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.69	40	40	40				93.76	38	38	38										40	40	40				38	38	38			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	024	0	1	02	01	H5475_024_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	024	0	1	02	01	H5475_024_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	026	0	1	02	01	H5475_026_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	026	0	1	02	01	H5475_026_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H5475	026	0	1	02	01	H5475_026_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H5475	026	0	1	02	01	H5475_026_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.51	42	42	42				93.82	40	40	40										42	42	42				40	40	40			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	026	0	1	02	01	H5475_026_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	026	0	1	02	01	H5475_026_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	029	0	1	02	01	H5475_029_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5475	029	0	1	02	01	H5475_029_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2	2	3
H5475	029	0	1	02	01	H5475_029_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H5475	029	0	1	02	01	H5475_029_0	4	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		
H5475	029	0	1	02	01	H5475_029_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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 Diabetic Drugs												
H5475	029	0	1	02	01	H5475_029_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Diabetic Drugs												
H5475	029	0	1	02	01	H5475_029_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5475	029	0	1	02	01	H5475_029_0	4	Select Diabetic Drugs	4	10	1	2	6	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	22.00	33.00				11.00	22.00	22.00				11.00				11.00			0.37	0.37		0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5475	029	0	1	02	01	H5475_029_0	4	Select Diabetic Drugs	4	10	1	2	6	3		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	22.00	33.00				11.00	22.00	22.00				11.00				11.00			0.37	0.37		0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2		
H5475	031	0	1	01	01	H5475_031_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	031	0	1	01	01	H5475_031_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	031	0	1	01	01	H5475_031_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5475	031	0	1	01	01	H5475_031_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.69	50	50	50				95.70	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	031	0	1	01	01	H5475_031_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	031	0	1	01	01	H5475_031_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	032	0	1	01	01	H5475_032_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	032	0	1	01	01	H5475_032_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	032	0	1	01	01	H5475_032_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5475	032	0	1	01	01	H5475_032_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.27	50	50	50				94.34	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	032	0	1	01	01	H5475_032_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	032	0	1	01	01	H5475_032_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	033	0	1	01	01	H5475_033_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	033	0	1	01	01	H5475_033_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H5475	033	0	1	01	01	H5475_033_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5475	033	0	1	01	01	H5475_033_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5475	033	0	1	01	01	H5475_033_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	033	0	1	01	01	H5475_033_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	034	0	1	01	01	H5475_034_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	034	0	1	01	01	H5475_034_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H5475	034	0	1	01	01	H5475_034_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H5475	034	0	1	01	01	H5475_034_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5475	034	0	1	01	01	H5475_034_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	034	0	1	01	01	H5475_034_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	035	0	1	02	01	H5475_035_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	035	0	1	02	01	H5475_035_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	16.00	32.00	48.00																									16.00	32.00	48.00				16.00	32.00	0.00				16.00				16.00		0.53				0.53	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	035	0	1	02	01	H5475_035_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	035	0	1	02	01	H5475_035_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				96.34	45	45	45																								45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	035	0	1	02	01	H5475_035_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	035	0	1	02	01	H5475_035_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	036	0	1	02	01	H5475_036_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	036	0	1	02	01	H5475_036_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	036	0	1	02	01	H5475_036_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H5475	036	0	1	02	01	H5475_036_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5475	036	0	1	02	01	H5475_036_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	036	0	1	02	01	H5475_036_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	038	0	1	01	01	H5475_038_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	038	0	1	01	01	H5475_038_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	038	0	1	01	01	H5475_038_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H5475	038	0	1	01	01	H5475_038_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.10	41	41	41																								41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	038	0	1	01	01	H5475_038_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	038	0	1	01	01	H5475_038_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5496	005	0	1	01	01	H5496_005_0	8	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				747.57	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	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	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				728.85	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	009	0	1	01	01	H5496_009_0	8	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	8	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	8	Generic	4	11	3	1	2	1	110		01	100		1	30		90				1	2			90				30		31				14.25	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	009	0	1	01	01	H5496_009_0	8	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	8	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				122.35	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	009	0	1	01	01	H5496_009_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				45.31	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	009	0	1	01	01	H5496_009_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				708.91	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	011	0	1	01	01	H5496_011_0	8	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	8	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	8	Generic	4	11	3	1	2	1	110		01	100		1	30		90				1	2			90				30		31				14.32	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	011	0	1	01	01	H5496_011_0	8	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	8	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				122.63	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	011	0	1	01	01	H5496_011_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				45.60	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	011	0	1	01	01	H5496_011_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				709.67	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	012	0	1	01	01	H5496_012_0	8	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				661.73	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	013	0	1	04	01	H5521_013_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											868.61	28						268.95	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	015	0	1	04	01	H5521_015_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	015	0	1	04	01	H5521_015_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											650.53	28						214.34	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	7	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	016	0	1	04	01	H5521_016_0	7	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	7	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	016	0	1	04	01	H5521_016_0	7	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1011.55	33						287.76	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	020	0	1	04	01	H5521_020_0	2	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					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												
H5521	020	0	1	04	01	H5521_020_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1079.94	33						227.90	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H5521	022	0	1	04	01	H5521_022_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											989.41	33						210.63	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	027	0	1	04	01	H5521_027_0	2	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					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												
H5521	027	0	1	04	01	H5521_027_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	027	0	1	04	01	H5521_027_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											693.67	28						174.63	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	033	0	1	04	01	H5521_033_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	033	0	1	04	01	H5521_033_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											900.22	28						615.96	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	037	0	1	04	01	H5521_037_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											938.71	28						490.07	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	040	0	1	04	01	H5521_040_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											789.33	28						553.25	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H5521	053	0	1	04	01	H5521_053_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											736.02	33						149.17	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H5521	055	0	1	04	01	H5521_055_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1020.85	33						364.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H5521	056	0	1	04	01	H5521_056_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											964.15	33						201.89	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	057	0	1	04	01	H5521_057_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	057	0	1	04	01	H5521_057_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	057	0	1	04	01	H5521_057_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	057	0	1	04	01	H5521_057_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	057	0	1	04	01	H5521_057_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											684.94	33						166.08	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	076	0	1	04	01	H5521_076_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											872.99	28						340.37	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	077	0	1	04	01	H5521_077_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											867.34	28						479.57	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	081	0	1	04	01	H5521_081_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	081	0	1	04	01	H5521_081_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											916.46	30						663.94	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					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												
H5521	082	0	1	04	01	H5521_082_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	082	0	1	04	01	H5521_082_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											808.62	28						206.22	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											703.83	29						338.98	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	084	0	1	04	01	H5521_084_0	2	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					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												
H5521	084	0	1	04	01	H5521_084_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	084	0	1	04	01	H5521_084_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											795.90	28						265.77	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	085	0	1	04	01	H5521_085_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1042.86	33						375.29	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	7	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	7	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	7	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					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												
H5521	086	0	1	04	01	H5521_086_0	7	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											945.95	33						459.03	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	087	0	1	04	01	H5521_087_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											977.73	30						765.27	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	088	0	1	04	01	H5521_088_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											808.11	30						636.58	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H5521	089	0	1	04	01	H5521_089_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1161.77	33						520.28	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H5521	090	0	1	04	01	H5521_090_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1020.23	30						425.03	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1069.98	29						616.02	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	095	0	1	04	01	H5521_095_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	095	0	1	04	01	H5521_095_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											897.89	33						207.65	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					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												
H5521	099	0	1	04	01	H5521_099_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1036.52	33						680.32	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	100	0	1	04	01	H5521_100_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	100	0	1	04	01	H5521_100_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	100	0	1	04	01	H5521_100_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	100	0	1	04	01	H5521_100_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	100	0	1	04	01	H5521_100_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											935.92	33						389.87	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	101	0	1	04	01	H5521_101_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	101	0	1	04	01	H5521_101_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											926.92	33						358.04	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	102	0	1	04	01	H5521_102_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	102	0	1	04	01	H5521_102_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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		
H5521	102	0	1	04	01	H5521_102_0	2	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					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												
H5521	102	0	1	04	01	H5521_102_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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		
H5521	102	0	1	04	01	H5521_102_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	102	0	1	04	01	H5521_102_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	102	0	1	04	01	H5521_102_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											862.16	28						207.42	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	110	0	1	04	01	H5521_110_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											937.24	28						544.44	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											820.13	30						431.45	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	117	0	1	04	01	H5521_117_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	117	0	1	04	01	H5521_117_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	117	0	1	04	01	H5521_117_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	117	0	1	04	01	H5521_117_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	117	0	1	04	01	H5521_117_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	117	0	1	04	01	H5521_117_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											883.27	28						218.58	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	118	0	1	04	01	H5521_118_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											987.48	28						372.22	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	119	0	1	04	01	H5521_119_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	119	0	1	04	01	H5521_119_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	119	0	1	04	01	H5521_119_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	119	0	1	04	01	H5521_119_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	119	0	1	04	01	H5521_119_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	119	0	1	04	01	H5521_119_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											941.86	28						416.00	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											812.17	28						459.02	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	121	0	1	04	01	H5521_121_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	121	0	1	04	01	H5521_121_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	121	0	1	04	01	H5521_121_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	121	0	1	04	01	H5521_121_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	121	0	1	04	01	H5521_121_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	121	0	1	04	01	H5521_121_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											786.78	28						209.47	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	122	0	1	04	01	H5521_122_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	122	0	1	04	01	H5521_122_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	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					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												
H5521	122	0	1	04	01	H5521_122_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	122	0	1	04	01	H5521_122_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	122	0	1	04	01	H5521_122_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1072.48	33						207.62	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	123	0	1	04	01	H5521_123_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	123	0	1	04	01	H5521_123_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	123	0	1	04	01	H5521_123_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	123	0	1	04	01	H5521_123_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	123	0	1	04	01	H5521_123_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	123	0	1	04	01	H5521_123_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											820.84	28						509.29	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	124	0	1	04	01	H5521_124_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	124	0	1	04	01	H5521_124_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	124	0	1	04	01	H5521_124_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	124	0	1	04	01	H5521_124_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	124	0	1	04	01	H5521_124_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											865.54	28						244.14	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	125	0	1	04	01	H5521_125_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	125	0	1	04	01	H5521_125_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H5521	125	0	1	04	01	H5521_125_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	125	0	1	04	01	H5521_125_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	125	0	1	04	01	H5521_125_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											707.80	33						201.93	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	127	0	1	04	01	H5521_127_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	127	0	1	04	01	H5521_127_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	127	0	1	04	01	H5521_127_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	127	0	1	04	01	H5521_127_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	127	0	1	04	01	H5521_127_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											921.43	33						246.25	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	128	0	1	04	01	H5521_128_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	128	0	1	04	01	H5521_128_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	128	0	1	04	01	H5521_128_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	128	0	1	04	01	H5521_128_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	128	0	1	04	01	H5521_128_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1156.06	33						574.16	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					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												
H5521	134	0	1	04	01	H5521_134_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											821.03	30						204.86	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	139	0	1	04	01	H5521_139_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	139	0	1	04	01	H5521_139_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	139	0	1	04	01	H5521_139_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	139	0	1	04	01	H5521_139_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	139	0	1	04	01	H5521_139_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	139	0	1	04	01	H5521_139_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1141.63	30						574.72	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	140	0	1	04	01	H5521_140_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	140	0	1	04	01	H5521_140_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	140	0	1	04	01	H5521_140_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	140	0	1	04	01	H5521_140_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	140	0	1	04	01	H5521_140_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	140	0	1	04	01	H5521_140_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	140	0	1	04	01	H5521_140_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											900.79	30						562.93	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	141	0	1	04	01	H5521_141_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	141	0	1	04	01	H5521_141_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	141	0	1	04	01	H5521_141_0	2	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					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												
H5521	141	0	1	04	01	H5521_141_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	141	0	1	04	01	H5521_141_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	141	0	1	04	01	H5521_141_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	141	0	1	04	01	H5521_141_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											889.23	33						582.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	142	0	1	04	01	H5521_142_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	142	0	1	04	01	H5521_142_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	142	0	1	04	01	H5521_142_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	142	0	1	04	01	H5521_142_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	142	0	1	04	01	H5521_142_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1011.15	28						313.35	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	143	0	1	04	01	H5521_143_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	143	0	1	04	01	H5521_143_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	143	0	1	04	01	H5521_143_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	143	0	1	04	01	H5521_143_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	143	0	1	04	01	H5521_143_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	143	0	1	04	01	H5521_143_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											848.88	28						397.77	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	144	0	1	04	01	H5521_144_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	144	0	1	04	01	H5521_144_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	144	0	1	04	01	H5521_144_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	144	0	1	04	01	H5521_144_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	144	0	1	04	01	H5521_144_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											871.56	28						404.23	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											943.30	29						352.75	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	154	0	1	04	01	H5521_154_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	154	0	1	04	01	H5521_154_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	154	0	1	04	01	H5521_154_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	154	0	1	04	01	H5521_154_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	154	0	1	04	01	H5521_154_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											877.56	33						356.77	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	156	0	1	04	01	H5521_156_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	156	0	1	04	01	H5521_156_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					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												
H5521	156	0	1	04	01	H5521_156_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	156	0	1	04	01	H5521_156_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	156	0	1	04	01	H5521_156_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											787.23	33						443.03	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	157	0	1	04	01	H5521_157_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	157	0	1	04	01	H5521_157_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	157	0	1	04	01	H5521_157_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	157	0	1	04	01	H5521_157_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	157	0	1	04	01	H5521_157_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	157	0	1	04	01	H5521_157_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	157	0	1	04	01	H5521_157_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1037.75	33						523.93	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	159	0	1	04	01	H5521_159_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	159	0	1	04	01	H5521_159_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	159	0	1	04	01	H5521_159_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	159	0	1	04	01	H5521_159_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	159	0	1	04	01	H5521_159_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	159	0	1	04	01	H5521_159_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	159	0	1	04	01	H5521_159_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											756.90	33						548.52	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	160	0	1	04	01	H5521_160_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	160	0	1	04	01	H5521_160_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	160	0	1	04	01	H5521_160_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	160	0	1	04	01	H5521_160_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	160	0	1	04	01	H5521_160_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											928.44	33						514.16	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	168	0	1	04	01	H5521_168_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	168	0	1	04	01	H5521_168_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	168	0	1	04	01	H5521_168_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	168	0	1	04	01	H5521_168_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	168	0	1	04	01	H5521_168_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											973.30	30						626.40	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	169	0	1	04	01	H5521_169_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	169	0	1	04	01	H5521_169_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	169	0	1	04	01	H5521_169_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	169	0	1	04	01	H5521_169_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	169	0	1	04	01	H5521_169_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	169	0	1	04	01	H5521_169_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	169	0	1	04	01	H5521_169_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											974.74	30						636.09	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	170	0	1	04	01	H5521_170_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	170	0	1	04	01	H5521_170_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	170	0	1	04	01	H5521_170_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	170	0	1	04	01	H5521_170_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	170	0	1	04	01	H5521_170_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	170	0	1	04	01	H5521_170_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	170	0	1	04	01	H5521_170_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1121.50	33						570.78	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	171	0	1	04	01	H5521_171_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	171	0	1	04	01	H5521_171_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	171	0	1	04	01	H5521_171_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	171	0	1	04	01	H5521_171_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	171	0	1	04	01	H5521_171_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											714.94	30						371.52	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	177	0	1	04	01	H5521_177_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	177	0	1	04	01	H5521_177_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	177	0	1	04	01	H5521_177_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	177	0	1	04	01	H5521_177_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	177	0	1	04	01	H5521_177_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	177	0	1	04	01	H5521_177_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1004.12	30						398.24	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	178	0	1	04	01	H5521_178_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	178	0	1	04	01	H5521_178_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	178	0	1	04	01	H5521_178_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	178	0	1	04	01	H5521_178_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	178	0	1	04	01	H5521_178_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											654.33	30						477.14	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	184	0	1	04	01	H5521_184_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	184	0	1	04	01	H5521_184_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	184	0	1	04	01	H5521_184_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	184	0	1	04	01	H5521_184_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	184	0	1	04	01	H5521_184_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											948.71	33						273.20	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	190	0	1	04	01	H5521_190_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	190	0	1	04	01	H5521_190_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					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												
H5521	190	0	1	04	01	H5521_190_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	190	0	1	04	01	H5521_190_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	190	0	1	04	01	H5521_190_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1002.83	33						402.98	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	194	0	1	04	01	H5521_194_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	194	0	1	04	01	H5521_194_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	194	0	1	04	01	H5521_194_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	194	0	1	04	01	H5521_194_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	194	0	1	04	01	H5521_194_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											707.85	33						445.41	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	195	0	1	04	01	H5521_195_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	195	0	1	04	01	H5521_195_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	195	0	1	04	01	H5521_195_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	195	0	1	04	01	H5521_195_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	195	0	1	04	01	H5521_195_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											767.33	29						638.09	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	196	0	1	04	01	H5521_196_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	196	0	1	04	01	H5521_196_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	196	0	1	04	01	H5521_196_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	196	0	1	04	01	H5521_196_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	196	0	1	04	01	H5521_196_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	196	0	1	04	01	H5521_196_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											933.54	33						380.51	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	197	0	1	04	01	H5521_197_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	197	0	1	04	01	H5521_197_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	197	0	1	04	01	H5521_197_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	197	0	1	04	01	H5521_197_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	197	0	1	04	01	H5521_197_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1048.73	31						427.10	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	200	0	1	04	01	H5521_200_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	200	0	1	04	01	H5521_200_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H5521	200	0	1	04	01	H5521_200_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	200	0	1	04	01	H5521_200_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	200	0	1	04	01	H5521_200_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	200	0	1	04	01	H5521_200_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											907.95	28						366.90	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	205	0	1	04	01	H5521_205_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	205	0	1	04	01	H5521_205_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H5521	205	0	1	04	01	H5521_205_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	205	0	1	04	01	H5521_205_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	205	0	1	04	01	H5521_205_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											957.73	33						361.82	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	206	0	1	04	01	H5521_206_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	206	0	1	04	01	H5521_206_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H5521	206	0	1	04	01	H5521_206_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	206	0	1	04	01	H5521_206_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	206	0	1	04	01	H5521_206_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											972.83	33						381.47	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	207	0	1	04	01	H5521_207_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	207	0	1	04	01	H5521_207_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	207	0	1	04	01	H5521_207_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	207	0	1	04	01	H5521_207_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	207	0	1	04	01	H5521_207_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											915.50	33						476.64	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	211	0	1	04	01	H5521_211_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	211	0	1	04	01	H5521_211_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					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												
H5521	211	0	1	04	01	H5521_211_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	211	0	1	04	01	H5521_211_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	211	0	1	04	01	H5521_211_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											847.39	33						424.89	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	214	0	1	04	01	H5521_214_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	214	0	1	04	01	H5521_214_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					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												
H5521	214	0	1	04	01	H5521_214_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	214	0	1	04	01	H5521_214_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	214	0	1	04	01	H5521_214_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											837.63	33						667.43	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	215	0	1	04	01	H5521_215_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	215	0	1	04	01	H5521_215_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	215	0	1	04	01	H5521_215_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	215	0	1	04	01	H5521_215_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	215	0	1	04	01	H5521_215_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	215	0	1	04	01	H5521_215_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											728.28	28						382.29	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	216	0	1	04	01	H5521_216_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	216	0	1	04	01	H5521_216_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	216	0	1	04	01	H5521_216_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	216	0	1	04	01	H5521_216_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	216	0	1	04	01	H5521_216_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											858.85	33						531.41	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	217	0	1	04	01	H5521_217_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	217	0	1	04	01	H5521_217_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	217	0	1	04	01	H5521_217_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	217	0	1	04	01	H5521_217_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	217	0	1	04	01	H5521_217_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											866.71	33						311.49	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	218	0	1	04	01	H5521_218_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	218	0	1	04	01	H5521_218_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	218	0	1	04	01	H5521_218_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	218	0	1	04	01	H5521_218_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	218	0	1	04	01	H5521_218_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											986.53	30						507.43	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	219	0	1	04	01	H5521_219_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	219	0	1	04	01	H5521_219_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	219	0	1	04	01	H5521_219_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	219	0	1	04	01	H5521_219_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	219	0	1	04	01	H5521_219_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											986.96	33						487.18	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	220	0	1	04	01	H5521_220_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	220	0	1	04	01	H5521_220_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	220	0	1	04	01	H5521_220_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	220	0	1	04	01	H5521_220_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	220	0	1	04	01	H5521_220_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											839.01	30						389.09	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	222	0	1	04	01	H5521_222_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	222	0	1	04	01	H5521_222_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	222	0	1	04	01	H5521_222_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	222	0	1	04	01	H5521_222_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	222	0	1	04	01	H5521_222_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											790.62	30						495.26	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	223	0	1	04	01	H5521_223_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	223	0	1	04	01	H5521_223_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					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												
H5521	223	0	1	04	01	H5521_223_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	223	0	1	04	01	H5521_223_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	223	0	1	04	01	H5521_223_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											869.26	33						378.57	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	224	0	1	04	01	H5521_224_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	224	0	1	04	01	H5521_224_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	224	0	1	04	01	H5521_224_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	224	0	1	04	01	H5521_224_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	224	0	1	04	01	H5521_224_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											758.11	30						438.34	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	226	0	1	04	01	H5521_226_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	226	0	1	04	01	H5521_226_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					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												
H5521	226	0	1	04	01	H5521_226_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	226	0	1	04	01	H5521_226_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	226	0	1	04	01	H5521_226_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											948.65	33						303.85	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	227	0	1	04	01	H5521_227_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	227	0	1	04	01	H5521_227_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	227	0	1	04	01	H5521_227_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	227	0	1	04	01	H5521_227_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	227	0	1	04	01	H5521_227_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											810.91	30						411.06	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	228	0	1	04	01	H5521_228_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	228	0	1	04	01	H5521_228_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	228	0	1	04	01	H5521_228_0	3	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					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												
H5521	228	0	1	04	01	H5521_228_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	228	0	1	04	01	H5521_228_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	228	0	1	04	01	H5521_228_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	228	0	1	04	01	H5521_228_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											863.81	33						433.58	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	230	0	1	04	01	H5521_230_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	230	0	1	04	01	H5521_230_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	230	0	1	04	01	H5521_230_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	230	0	1	04	01	H5521_230_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	230	0	1	04	01	H5521_230_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											884.11	30						487.33	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	231	0	1	04	01	H5521_231_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	231	0	1	04	01	H5521_231_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	231	0	1	04	01	H5521_231_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	231	0	1	04	01	H5521_231_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	231	0	1	04	01	H5521_231_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	231	0	1	04	01	H5521_231_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											922.17	33						458.08	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	232	0	1	04	01	H5521_232_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	232	0	1	04	01	H5521_232_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	232	0	1	04	01	H5521_232_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	232	0	1	04	01	H5521_232_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	232	0	1	04	01	H5521_232_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											711.20	30						425.76	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	233	0	1	04	01	H5521_233_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	233	0	1	04	01	H5521_233_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	233	0	1	04	01	H5521_233_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	233	0	1	04	01	H5521_233_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	233	0	1	04	01	H5521_233_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											839.81	30						454.85	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	234	0	1	04	01	H5521_234_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	234	0	1	04	01	H5521_234_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	234	0	1	04	01	H5521_234_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	234	0	1	04	01	H5521_234_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	234	0	1	04	01	H5521_234_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											890.24	30						483.81	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	236	0	1	04	01	H5521_236_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	236	0	1	04	01	H5521_236_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	236	0	1	04	01	H5521_236_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	236	0	1	04	01	H5521_236_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	236	0	1	04	01	H5521_236_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	236	0	1	04	01	H5521_236_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											845.86	30						456.77	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	239	0	1	04	01	H5521_239_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	239	0	1	04	01	H5521_239_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	239	0	1	04	01	H5521_239_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	239	0	1	04	01	H5521_239_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	239	0	1	04	01	H5521_239_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	239	0	1	04	01	H5521_239_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											970.12	30						428.69	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	243	0	1	04	01	H5521_243_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	243	0	1	04	01	H5521_243_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	243	0	1	04	01	H5521_243_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	243	0	1	04	01	H5521_243_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	243	0	1	04	01	H5521_243_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	243	0	1	04	01	H5521_243_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											769.02	30						459.89	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	245	0	1	04	01	H5521_245_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	245	0	1	04	01	H5521_245_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	245	0	1	04	01	H5521_245_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	245	0	1	04	01	H5521_245_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	245	0	1	04	01	H5521_245_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1083.75	33						486.94	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	246	0	1	04	01	H5521_246_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	246	0	1	04	01	H5521_246_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	246	0	1	04	01	H5521_246_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	246	0	1	04	01	H5521_246_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	246	0	1	04	01	H5521_246_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											971.74	33						353.47	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	247	0	1	04	01	H5521_247_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	247	0	1	04	01	H5521_247_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	247	0	1	04	01	H5521_247_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	247	0	1	04	01	H5521_247_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	247	0	1	04	01	H5521_247_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											747.45	33						282.69	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	249	0	1	04	01	H5521_249_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	249	0	1	04	01	H5521_249_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	249	0	1	04	01	H5521_249_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	249	0	1	04	01	H5521_249_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	249	0	1	04	01	H5521_249_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	249	0	1	04	01	H5521_249_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1022.14	30						498.59	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	250	0	1	04	01	H5521_250_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	250	0	1	04	01	H5521_250_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	250	0	1	04	01	H5521_250_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	250	0	1	04	01	H5521_250_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	250	0	1	04	01	H5521_250_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	250	0	1	04	01	H5521_250_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											843.38	33						392.35	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	251	0	1	04	01	H5521_251_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	251	0	1	04	01	H5521_251_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	251	0	1	04	01	H5521_251_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	251	0	1	04	01	H5521_251_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	251	0	1	04	01	H5521_251_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	251	0	1	04	01	H5521_251_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											885.10	30						391.15	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	252	0	1	04	01	H5521_252_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	252	0	1	04	01	H5521_252_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					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												
H5521	252	0	1	04	01	H5521_252_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	252	0	1	04	01	H5521_252_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	252	0	1	04	01	H5521_252_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	252	0	1	04	01	H5521_252_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											962.00	31						455.36	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	254	0	1	04	01	H5521_254_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	254	0	1	04	01	H5521_254_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					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												
H5521	254	0	1	04	01	H5521_254_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	254	0	1	04	01	H5521_254_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	254	0	1	04	01	H5521_254_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											943.60	33						369.65	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	259	0	1	04	01	H5521_259_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	259	0	1	04	01	H5521_259_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	259	0	1	04	01	H5521_259_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	259	0	1	04	01	H5521_259_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	259	0	1	04	01	H5521_259_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											955.02	33						420.85	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	260	0	1	04	01	H5521_260_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	260	0	1	04	01	H5521_260_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					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												
H5521	260	0	1	04	01	H5521_260_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	260	0	1	04	01	H5521_260_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	260	0	1	04	01	H5521_260_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											909.59	33						452.92	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	261	0	1	04	01	H5521_261_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	261	0	1	04	01	H5521_261_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	261	0	1	04	01	H5521_261_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	261	0	1	04	01	H5521_261_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	261	0	1	04	01	H5521_261_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1060.34	33						503.24	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	262	0	1	04	01	H5521_262_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	262	0	1	04	01	H5521_262_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	262	0	1	04	01	H5521_262_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	262	0	1	04	01	H5521_262_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	262	0	1	04	01	H5521_262_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											735.04	27						467.68	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	263	0	1	04	01	H5521_263_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	263	0	1	04	01	H5521_263_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	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					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												
H5521	263	0	1	04	01	H5521_263_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	263	0	1	04	01	H5521_263_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	263	0	1	04	01	H5521_263_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1124.00	33						696.67	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	266	0	1	04	01	H5521_266_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	266	0	1	04	01	H5521_266_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	266	0	1	04	01	H5521_266_0	3	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					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												
H5521	266	0	1	04	01	H5521_266_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	266	0	1	04	01	H5521_266_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	266	0	1	04	01	H5521_266_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											906.94	33						462.14	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	267	0	1	04	01	H5521_267_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	267	0	1	04	01	H5521_267_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					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												
H5521	267	0	1	04	01	H5521_267_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	267	0	1	04	01	H5521_267_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	267	0	1	04	01	H5521_267_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											893.49	33						483.93	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	268	0	1	04	01	H5521_268_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	268	0	1	04	01	H5521_268_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	268	0	1	04	01	H5521_268_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	268	0	1	04	01	H5521_268_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	268	0	1	04	01	H5521_268_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											945.32	30						533.33	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	269	0	1	04	01	H5521_269_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	269	0	1	04	01	H5521_269_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	269	0	1	04	01	H5521_269_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	269	0	1	04	01	H5521_269_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	269	0	1	04	01	H5521_269_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											967.51	30						480.24	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	270	0	1	04	01	H5521_270_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	270	0	1	04	01	H5521_270_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	270	0	1	04	01	H5521_270_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	270	0	1	04	01	H5521_270_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	270	0	1	04	01	H5521_270_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											978.01	30						557.02	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	271	0	1	04	01	H5521_271_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	271	0	1	04	01	H5521_271_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	271	0	1	04	01	H5521_271_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	271	0	1	04	01	H5521_271_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	271	0	1	04	01	H5521_271_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1084.92	30						628.37	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	272	0	1	04	01	H5521_272_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	272	0	1	04	01	H5521_272_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	272	0	1	04	01	H5521_272_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	272	0	1	04	01	H5521_272_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	272	0	1	04	01	H5521_272_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1047.20	30						625.86	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	273	0	1	04	01	H5521_273_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	273	0	1	04	01	H5521_273_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	273	0	1	04	01	H5521_273_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	273	0	1	04	01	H5521_273_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	273	0	1	04	01	H5521_273_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											906.34	30						424.44	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	275	0	1	04	01	H5521_275_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	275	0	1	04	01	H5521_275_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	275	0	1	04	01	H5521_275_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	275	0	1	04	01	H5521_275_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	275	0	1	04	01	H5521_275_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	275	0	1	04	01	H5521_275_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											899.50	27						229.63	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	277	0	1	04	01	H5521_277_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	277	0	1	04	01	H5521_277_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	277	0	1	04	01	H5521_277_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	277	0	1	04	01	H5521_277_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	277	0	1	04	01	H5521_277_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	277	0	1	04	01	H5521_277_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											990.22	27						333.46	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	278	0	1	04	01	H5521_278_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	278	0	1	04	01	H5521_278_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	278	0	1	04	01	H5521_278_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	278	0	1	04	01	H5521_278_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	278	0	1	04	01	H5521_278_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	278	0	1	04	01	H5521_278_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											879.88	28						502.38	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	280	0	1	04	01	H5521_280_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	280	0	1	04	01	H5521_280_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	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					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												
H5521	280	0	1	04	01	H5521_280_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	280	0	1	04	01	H5521_280_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	280	0	1	04	01	H5521_280_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											962.19	33						455.06	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	281	0	1	04	01	H5521_281_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	281	0	1	04	01	H5521_281_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	281	0	1	04	01	H5521_281_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	281	0	1	04	01	H5521_281_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	281	0	1	04	01	H5521_281_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											919.10	33						401.36	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	282	0	1	04	01	H5521_282_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	282	0	1	04	01	H5521_282_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	282	0	1	04	01	H5521_282_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H5521	282	0	1	04	01	H5521_282_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H5521	282	0	1	04	01	H5521_282_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1021.42	33						495.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	283	0	1	04	01	H5521_283_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	283	0	1	04	01	H5521_283_0	4	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	283	0	1	04	01	H5521_283_0	4	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	283	0	1	04	01	H5521_283_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	283	0	1	04	01	H5521_283_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											955.01	33						456.88	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	284	0	1	04	01	H5521_284_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	284	0	1	04	01	H5521_284_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	284	0	1	04	01	H5521_284_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	284	0	1	04	01	H5521_284_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	284	0	1	04	01	H5521_284_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											924.02	33						456.32	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	285	0	1	04	01	H5521_285_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	285	0	1	04	01	H5521_285_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	285	0	1	04	01	H5521_285_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	285	0	1	04	01	H5521_285_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	285	0	1	04	01	H5521_285_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											931.35	33						486.57	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	288	0	1	04	01	H5521_288_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	288	0	1	04	01	H5521_288_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	288	0	1	04	01	H5521_288_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	288	0	1	04	01	H5521_288_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	288	0	1	04	01	H5521_288_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											824.51	33						411.30	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	289	0	1	04	01	H5521_289_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	289	0	1	04	01	H5521_289_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	289	0	1	04	01	H5521_289_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	289	0	1	04	01	H5521_289_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	289	0	1	04	01	H5521_289_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											921.66	29						402.59	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	290	0	1	04	01	H5521_290_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	290	0	1	04	01	H5521_290_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	290	0	1	04	01	H5521_290_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	290	0	1	04	01	H5521_290_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	290	0	1	04	01	H5521_290_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											987.29	33						401.39	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	292	0	1	04	01	H5521_292_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	292	0	1	04	01	H5521_292_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					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												
H5521	292	0	1	04	01	H5521_292_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	292	0	1	04	01	H5521_292_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	292	0	1	04	01	H5521_292_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											970.58	33						373.30	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	293	0	1	04	01	H5521_293_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	293	0	1	04	01	H5521_293_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	293	0	1	04	01	H5521_293_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	293	0	1	04	01	H5521_293_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	293	0	1	04	01	H5521_293_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											925.75	33						428.10	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	294	0	1	04	01	H5521_294_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	294	0	1	04	01	H5521_294_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	294	0	1	04	01	H5521_294_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	294	0	1	04	01	H5521_294_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	294	0	1	04	01	H5521_294_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1004.22	33						406.50	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	295	0	1	04	01	H5521_295_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	295	0	1	04	01	H5521_295_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	295	0	1	04	01	H5521_295_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	295	0	1	04	01	H5521_295_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	295	0	1	04	01	H5521_295_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	295	0	1	04	01	H5521_295_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											952.11	28						330.09	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	298	0	1	04	01	H5521_298_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	298	0	1	04	01	H5521_298_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	298	0	1	04	01	H5521_298_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	298	0	1	04	01	H5521_298_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	298	0	1	04	01	H5521_298_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	298	0	1	04	01	H5521_298_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											952.11	28						330.09	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	299	0	1	04	01	H5521_299_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	299	0	1	04	01	H5521_299_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	299	0	1	04	01	H5521_299_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	299	0	1	04	01	H5521_299_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	299	0	1	04	01	H5521_299_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											968.04	33						407.11	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	300	0	1	04	01	H5521_300_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	300	0	1	04	01	H5521_300_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	300	0	1	04	01	H5521_300_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	300	0	1	04	01	H5521_300_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	300	0	1	04	01	H5521_300_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1002.37	33						377.71	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	301	0	1	04	01	H5521_301_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	301	0	1	04	01	H5521_301_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H5521	301	0	1	04	01	H5521_301_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	301	0	1	04	01	H5521_301_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	301	0	1	04	01	H5521_301_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											968.05	33						407.14	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	302	0	1	04	01	H5521_302_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	302	0	1	04	01	H5521_302_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	302	0	1	04	01	H5521_302_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	302	0	1	04	01	H5521_302_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	302	0	1	04	01	H5521_302_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											943.97	33						451.75	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	303	0	1	04	01	H5521_303_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	303	0	1	04	01	H5521_303_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	303	0	1	04	01	H5521_303_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	303	0	1	04	01	H5521_303_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	303	0	1	04	01	H5521_303_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											968.04	33						407.11	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	304	0	1	04	01	H5521_304_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	304	0	1	04	01	H5521_304_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					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												
H5521	304	0	1	04	01	H5521_304_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	304	0	1	04	01	H5521_304_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	304	0	1	04	01	H5521_304_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											943.97	33						451.76	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	305	0	1	04	01	H5521_305_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	305	0	1	04	01	H5521_305_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	305	0	1	04	01	H5521_305_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	305	0	1	04	01	H5521_305_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	305	0	1	04	01	H5521_305_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											993.62	30						587.43	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	307	0	1	04	01	H5521_307_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	307	0	1	04	01	H5521_307_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					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												
H5521	307	0	1	04	01	H5521_307_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	307	0	1	04	01	H5521_307_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	307	0	1	04	01	H5521_307_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											960.26	33						419.02	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	309	0	1	04	01	H5521_309_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	309	0	1	04	01	H5521_309_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	309	0	1	04	01	H5521_309_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	309	0	1	04	01	H5521_309_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	309	0	1	04	01	H5521_309_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	309	0	1	04	01	H5521_309_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											899.89	27						333.83	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	310	0	1	04	01	H5521_310_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	310	0	1	04	01	H5521_310_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	310	0	1	04	01	H5521_310_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	310	0	1	04	01	H5521_310_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	310	0	1	04	01	H5521_310_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	310	0	1	04	01	H5521_310_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											929.97	28						344.14	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	311	0	1	04	01	H5521_311_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	311	0	1	04	01	H5521_311_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					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												
H5521	311	0	1	04	01	H5521_311_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	311	0	1	04	01	H5521_311_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	311	0	1	04	01	H5521_311_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											960.26	33						419.02	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	312	0	1	04	01	H5521_312_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	312	0	1	04	01	H5521_312_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	312	0	1	04	01	H5521_312_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	312	0	1	04	01	H5521_312_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	312	0	1	04	01	H5521_312_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	312	0	1	04	01	H5521_312_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											912.81	28						357.16	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	313	0	1	04	01	H5521_313_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	313	0	1	04	01	H5521_313_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	313	0	1	04	01	H5521_313_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	313	0	1	04	01	H5521_313_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	313	0	1	04	01	H5521_313_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	313	0	1	04	01	H5521_313_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											896.14	27						336.57	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	314	0	1	04	01	H5521_314_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	314	0	1	04	01	H5521_314_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	314	0	1	04	01	H5521_314_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	314	0	1	04	01	H5521_314_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	314	0	1	04	01	H5521_314_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											941.22	33						435.57	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	318	0	1	04	01	H5521_318_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	318	0	1	04	01	H5521_318_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	318	0	1	04	01	H5521_318_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	318	0	1	04	01	H5521_318_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	318	0	1	04	01	H5521_318_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	318	0	1	04	01	H5521_318_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											906.51	28						362.08	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	319	0	1	04	01	H5521_319_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	319	0	1	04	01	H5521_319_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	319	0	1	04	01	H5521_319_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	319	0	1	04	01	H5521_319_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	319	0	1	04	01	H5521_319_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1000.18	33						420.78	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	321	0	1	04	01	H5521_321_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	321	0	1	04	01	H5521_321_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	321	0	1	04	01	H5521_321_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	321	0	1	04	01	H5521_321_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	321	0	1	04	01	H5521_321_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											953.02	33						405.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	326	0	1	04	01	H5521_326_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	326	0	1	04	01	H5521_326_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	326	0	1	04	01	H5521_326_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	326	0	1	04	01	H5521_326_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	326	0	1	04	01	H5521_326_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											818.93	30						397.58	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	328	0	1	04	01	H5521_328_0	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	328	0	1	04	01	H5521_328_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	328	0	1	04	01	H5521_328_0	5	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5521	328	0	1	04	01	H5521_328_0	5	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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	328	0	1	04	01	H5521_328_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	328	0	1	04	01	H5521_328_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	328	0	1	04	01	H5521_328_0	5	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											974.31	33						433.59	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	331	0	1	04	01	H5521_331_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	331	0	1	04	01	H5521_331_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	331	0	1	04	01	H5521_331_0	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	331	0	1	04	01	H5521_331_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	331	0	1	04	01	H5521_331_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	331	0	1	04	01	H5521_331_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	331	0	1	04	01	H5521_331_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											987.29	33						401.39	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	332	0	1	04	01	H5521_332_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	332	0	1	04	01	H5521_332_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	332	0	1	04	01	H5521_332_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	332	0	1	04	01	H5521_332_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	332	0	1	04	01	H5521_332_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	332	0	1	04	01	H5521_332_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	332	0	1	04	01	H5521_332_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											975.35	33						367.79	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	333	0	1	04	01	H5521_333_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	333	0	1	04	01	H5521_333_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	333	0	1	04	01	H5521_333_0	2	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					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												
H5521	333	0	1	04	01	H5521_333_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	333	0	1	04	01	H5521_333_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	333	0	1	04	01	H5521_333_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	333	0	1	04	01	H5521_333_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											970.58	33						373.30	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	340	0	1	04	01	H5521_340_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	340	0	1	04	01	H5521_340_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	340	0	1	04	01	H5521_340_0	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	340	0	1	04	01	H5521_340_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	340	0	1	04	01	H5521_340_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	340	0	1	04	01	H5521_340_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	340	0	1	04	01	H5521_340_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											913.46	28						356.67	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	341	0	1	04	01	H5521_341_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	341	0	1	04	01	H5521_341_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	341	0	1	04	01	H5521_341_0	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	341	0	1	04	01	H5521_341_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	341	0	1	04	01	H5521_341_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	341	0	1	04	01	H5521_341_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	341	0	1	04	01	H5521_341_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											899.89	27						333.83	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	344	0	1	04	01	H5521_344_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	344	0	1	04	01	H5521_344_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	344	0	1	04	01	H5521_344_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5521	344	0	1	04	01	H5521_344_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	344	0	1	04	01	H5521_344_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	344	0	1	04	01	H5521_344_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	344	0	1	04	01	H5521_344_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											974.38	33						425.02	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	345	0	1	04	01	H5521_345_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	345	0	1	04	01	H5521_345_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	345	0	1	04	01	H5521_345_0	4	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					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												
H5521	345	0	1	04	01	H5521_345_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	345	0	1	04	01	H5521_345_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	345	0	1	04	01	H5521_345_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	345	0	1	04	01	H5521_345_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											974.40	33						425.04	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	348	0	1	04	01	H5521_348_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	348	0	1	04	01	H5521_348_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	348	0	1	04	01	H5521_348_0	3	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					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												
H5521	348	0	1	04	01	H5521_348_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	348	0	1	04	01	H5521_348_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	348	0	1	04	01	H5521_348_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	348	0	1	04	01	H5521_348_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											906.18	29						392.21	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	352	0	1	04	01	H5521_352_0	6	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	352	0	1	04	01	H5521_352_0	6	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	352	0	1	04	01	H5521_352_0	6	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	352	0	1	04	01	H5521_352_0	6	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	352	0	1	04	01	H5521_352_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	352	0	1	04	01	H5521_352_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	352	0	1	04	01	H5521_352_0	6	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											965.51	33						485.48	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	354	0	1	04	01	H5521_354_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	354	0	1	04	01	H5521_354_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	354	0	1	04	01	H5521_354_0	3	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					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												
H5521	354	0	1	04	01	H5521_354_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	354	0	1	04	01	H5521_354_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	354	0	1	04	01	H5521_354_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	354	0	1	04	01	H5521_354_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											906.18	29						392.21	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H5522	001	0	1	04	01	H5522_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5522	001	0	1	04	01	H5522_001_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1021.99	33						602.40	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
H5522	002	0	1	04	01	H5522_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H5522	002	0	1	04	01	H5522_002_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1047.24	33						605.53	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	004	0	1	04	01	H5522_004_0	2	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	004	0	1	04	01	H5522_004_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1189.96	33						520.74	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											936.98	33						594.25	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											963.19	33						700.07	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1086.32	33						406.34	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5522	017	0	1	04	01	H5522_017_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	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					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												
H5522	017	0	1	04	01	H5522_017_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											990.89	28						402.19	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	3	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	3	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1304.86	33						437.93	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	020	0	1	04	01	H5522_020_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	020	0	1	04	01	H5522_020_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	020	0	1	04	01	H5522_020_0	4	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					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												
H5522	020	0	1	04	01	H5522_020_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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		
H5522	020	0	1	04	01	H5522_020_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	020	0	1	04	01	H5522_020_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	020	0	1	04	01	H5522_020_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											886.82	28						349.33	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	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	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	Specialty Tier	4	11	1	1	5	1		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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	Specialty Tier	4	11	1	1	5	1		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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	036	0	1	04	01	H5525_036_0	6	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					4.00		12.00											5.00		15.00				4.00		0.00				5.00				5.00			0.17	0.13		0.17	0.13	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	036	0	1	04	01	H5525_036_0	6	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	036	0	1	04	01	H5525_036_0	6	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	036	0	1	04	01	H5525_036_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	036	0	1	04	01	H5525_036_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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												
H5525	037	0	1	04	01	H5525_037_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	039	0	1	04	01	H5525_039_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	039	0	1	04	01	H5525_039_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	039	0	1	04	01	H5525_039_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	039	0	1	04	01	H5525_039_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	039	0	1	04	01	H5525_039_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	040	0	1	04	01	H5525_040_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	040	0	1	04	01	H5525_040_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	040	0	1	04	01	H5525_040_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	040	0	1	04	01	H5525_040_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_041_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_041_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	044	0	1	04	01	H5525_044_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	044	0	1	04	01	H5525_044_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	044	0	1	04	01	H5525_044_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	044	0	1	04	01	H5525_044_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	044	0	1	04	01	H5525_044_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	045	0	1	04	01	H5525_045_0	7	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												
H5525	045	0	1	04	01	H5525_045_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	045	0	1	04	01	H5525_045_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	7	Specialty Tier	4	11	1	1	5	1		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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	046	0	1	04	01	H5525_046_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	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												
H5525	048	0	1	04	01	H5525_048_0	4	Preferred Generic	4	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		0.13	0	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	048	0	1	04	01	H5525_048_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	048	0	1	04	01	H5525_048_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	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												
H5525	049	0	1	04	01	H5525_049_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	050	0	1	04	01	H5525_050_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	050	0	1	04	01	H5525_050_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	050	0	1	04	01	H5525_050_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	050	0	1	04	01	H5525_050_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	050	0	1	04	01	H5525_050_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	1	1	04	01	H5525_051_1	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	051	1	1	04	01	H5525_051_1	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	1	1	04	01	H5525_051_1	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	1	1	04	01	H5525_051_1	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	1	1	04	01	H5525_051_1	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	2	1	04	01	H5525_051_2	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	051	2	1	04	01	H5525_051_2	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	2	1	04	01	H5525_051_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	2	1	04	01	H5525_051_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	2	1	04	01	H5525_051_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		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	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								13.00		39.00					8.00		24.00					8.00		20.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6	Preferred Brand	4	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	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								99.00		297.00					94.00		282.00					94.00		235.00																99.00				99.00			3.30	3.13	3.13			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	5	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								9.00		27.00					4.00		12.00					4.00		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	5	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	5	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					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	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	5	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	5	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		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	5	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	5	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					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	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	5	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	5	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								5.00		15.00					0.00		0.00					0.00		0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	020	0	1	04	01	H5526_020_0	5	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	5	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					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	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	020	0	1	04	01	H5526_020_0	5	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												
H5526	021	0	1	04	01	H5526_021_0	5	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								5.00		15.00					0.00		0.00					0.00		0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	021	0	1	04	01	H5526_021_0	5	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	5	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					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	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	021	0	1	04	01	H5526_021_0	5	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	022	0	1	04	01	H5526_022_0	5	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		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	022	0	1	04	01	H5526_022_0	5	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								19.00		57.00					14.00		42.00					14.00		35.00																19.00				19.00			0.63	0.47	0.47			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	022	0	1	04	01	H5526_022_0	5	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					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	022	0	1	04	01	H5526_022_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	022	0	1	04	01	H5526_022_0	5	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												27		27					27		27				27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	003	0	1	04	01	H5533_003_0	8	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	003	0	1	04	01	H5533_003_0	8	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	003	0	1	04	01	H5533_003_0	8	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					47.00	94.00	129.50													141.00						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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1613.67	33						787.47	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	005	0	1	04	01	H5533_005_0	8	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	005	0	1	04	01	H5533_005_0	8	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	005	0	1	04	01	H5533_005_0	8	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					47.00	94.00	129.50													141.00						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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1356.46	33						1122.88	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	007	0	1	04	01	H5533_007_0	7	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	007	0	1	04	01	H5533_007_0	7	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	007	0	1	04	01	H5533_007_0	7	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					47.00	94.00	129.50													141.00						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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1609.23	33						734.39	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	008	0	1	04	01	H5533_008_0	8	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	008	0	1	04	01	H5533_008_0	8	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	008	0	1	04	01	H5533_008_0	8	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					47.00	94.00	129.50													141.00						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	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					100.00	200.00	300.00													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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											843.23	33						810.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	009	0	1	04	01	H5533_009_0	6	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	009	0	1	04	01	H5533_009_0	6	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	009	0	1	04	01	H5533_009_0	6	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					47.00	94.00	129.50													141.00						117.50				47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	009	0	1	04	01	H5533_009_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	009	0	1	04	01	H5533_009_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1613.82	33						786.81	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	010	0	1	04	01	H5533_010_0	7	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	010	0	1	04	01	H5533_010_0	7	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	010	0	1	04	01	H5533_010_0	7	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					47.00	94.00	129.50													141.00						117.50				47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	010	0	1	04	01	H5533_010_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	010	0	1	04	01	H5533_010_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1613.82	33						786.81	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	011	0	1	04	01	H5533_011_0	6	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	30.00					0.00	0.00	0.00													30.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	011	0	1	04	01	H5533_011_0	6	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	40.00					10.00	20.00	20.00													40.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	011	0	1	04	01	H5533_011_0	6	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					47.00	94.00	129.50													141.00						117.50				47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	011	0	1	04	01	H5533_011_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					100.00	200.00	300.00													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	011	0	1	04	01	H5533_011_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1613.82	33						786.81	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	10	Preferred Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	13.00	26.00	39.00																					39.00																13.00				13.00		0.43						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	10	Generic	2	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	10	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	10	Non-Preferred Brand	2	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	10	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	012	0	1	01	01	H5549_012_0	7	Preferred Generic	3	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					45.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5549	012	0	1	01	01	H5549_012_0	7	Generic	3	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5549	012	0	1	01	01	H5549_012_0	7	Preferred Brand	3	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	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												
H5549	012	0	1	01	01	H5549_012_0	7	Non-Preferred Brand	3	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, Select Care Drugs												
H5549	012	0	1	01	01	H5549_012_0	7	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5549	012	0	1	01	01	H5549_012_0	7	Select Care Drugs	3	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 Care Drugs												
H5576	017	1	1	02	01	H5576_017_1	11	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	11	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	017	1	1	02	01	H5576_017_1	11	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	11	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	11	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	11	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											2048.38	25						1371.43	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	11	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	11	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	017	2	1	02	01	H5576_017_2	11	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	11	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	11	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	11	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											2048.38	25						1371.43	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	11	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	11	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	11	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	11	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	11	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	11	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											2428.46	33						1123.03	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	11	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	11	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	11	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	11	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	11	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	11	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											2428.46	33						1123.03	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	019	0	1	02	01	H5576_019_0	10	Preferred Generic	2	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	019	0	1	02	01	H5576_019_0	10	Generic	2	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								10.00		30.00					10.00		30.00													30.00						30.00				10.00				10.00			0.32	0.32				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	019	0	1	02	01	H5576_019_0	10	Preferred Brand	2	10	1	1	3	1		110	01		100	1				31		100	1	2						100	31		31											122.79	25		25				116.90	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	10	Non-Preferred Brand	2	10	1	1	4	1		110	01		100	1				31		100	1	2						100	31		31											144.75	25		25				119.92	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	10	Specialty Tier	2	10	1	1	5	1		010	01		010	1				31								31			31		31											1244.64	25						677.02	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	11	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	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 Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	11	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	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 Brand, Specialty Tier										1		
H5576	020	1	1	02	01	H5576_020_1	11	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								16.00		48.00					16.00		48.00													48.00						48.00				16.00				16.00			0.52	0.52				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	11	Preferred Brand	4	10	1	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	11	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	11	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1354.40	25						704.22	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	11	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	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 Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	11	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	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 Brand, Specialty Tier										1		
H5576	020	2	1	02	01	H5576_020_2	11	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								16.00		48.00					16.00		48.00													48.00						48.00				16.00				16.00			0.52	0.52				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	11	Preferred Brand	4	10	1	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	11	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	11	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1354.40	25						704.22	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	022	0	1	02	01	H5576_022_0	11	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	11	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	11	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	11	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	11	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	11	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											2504.86	33						1090.34	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	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 Diabetic Drugs												
H5577	005	0	1	01	01	H5577_005_0	4	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	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		
H5577	005	0	1	01	01	H5577_005_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	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												
H5577	005	0	1	01	01	H5577_005_0	4	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	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		3
H5577	005	0	1	01	01	H5577_005_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	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 Diabetic Drugs												
H5577	005	0	1	01	01	H5577_005_0	4	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 Diabetic Drugs												
H5577	005	0	1	01	01	H5577_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				911.00	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	005	0	1	01	01	H5577_005_0	4	Select Diabetic 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 Diabetic Drugs												
H5577	005	0	1	01	01	H5577_005_0	4	Select Diabetic 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 Diabetic Drugs										1		
H5577	008	0	1	02	01	H5577_008_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	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												
H5577	008	0	1	02	01	H5577_008_0	4	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	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		
H5577	008	0	1	02	01	H5577_008_0	4	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 Diabetic Drugs												
H5577	008	0	1	02	01	H5577_008_0	4	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 Diabetic Drugs										1		3
H5577	008	0	1	02	01	H5577_008_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	0.00	0.00	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												
H5577	008	0	1	02	01	H5577_008_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	1			90				30		31	0.00	0.00	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												
H5577	008	0	1	02	01	H5577_008_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	008	0	1	02	01	H5577_008_0	4	Select Diabetic 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 Diabetic Drugs												
H5577	008	0	1	02	01	H5577_008_0	4	Select Diabetic 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 Diabetic Drugs										1		
H5577	031	0	1	01	01	H5577_031_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	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												
H5577	031	0	1	01	01	H5577_031_0	4	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	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		
H5577	031	0	1	01	01	H5577_031_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	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												
H5577	031	0	1	01	01	H5577_031_0	4	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	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		3
H5577	031	0	1	01	01	H5577_031_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	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 Diabetic Drugs												
H5577	031	0	1	01	01	H5577_031_0	4	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 Diabetic Drugs												
H5577	031	0	1	01	01	H5577_031_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				911.00	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	031	0	1	01	01	H5577_031_0	4	Select Diabetic 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 Diabetic Drugs												
H5577	031	0	1	01	01	H5577_031_0	4	Select Diabetic 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 Diabetic Drugs										1		
H5577	038	0	1	01	01	H5577_038_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	038	0	1	01	01	H5577_038_0	4	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H5577	038	0	1	01	01	H5577_038_0	4	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 Diabetic Drugs												
H5577	038	0	1	01	01	H5577_038_0	4	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 Diabetic Drugs										1		3
H5577	038	0	1	01	01	H5577_038_0	4	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 Diabetic Drugs												
H5577	038	0	1	01	01	H5577_038_0	4	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 Diabetic Drugs												
H5577	038	0	1	01	01	H5577_038_0	4	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 Diabetic Drugs												
H5577	038	0	1	01	01	H5577_038_0	4	Select Diabetic 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 Diabetic Drugs												
H5577	038	0	1	01	01	H5577_038_0	4	Select Diabetic 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 Diabetic Drugs										1		
H5577	039	0	1	01	01	H5577_039_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	039	0	1	01	01	H5577_039_0	4	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H5577	039	0	1	01	01	H5577_039_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	039	0	1	01	01	H5577_039_0	4	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		3
H5577	039	0	1	01	01	H5577_039_0	4	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, Select Diabetic Drugs												
H5577	039	0	1	01	01	H5577_039_0	4	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, Select Diabetic Drugs												
H5577	039	0	1	01	01	H5577_039_0	4	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 Diabetic Drugs												
H5577	039	0	1	01	01	H5577_039_0	4	Select Diabetic 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 Diabetic Drugs												
H5577	039	0	1	01	01	H5577_039_0	4	Select Diabetic 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 Diabetic Drugs										1		
H5577	042	0	1	01	01	H5577_042_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	042	0	1	01	01	H5577_042_0	4	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H5577	042	0	1	01	01	H5577_042_0	4	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 Diabetic Drugs												
H5577	042	0	1	01	01	H5577_042_0	4	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 Diabetic Drugs										1		3
H5577	042	0	1	01	01	H5577_042_0	4	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 Diabetic Drugs												
H5577	042	0	1	01	01	H5577_042_0	4	Non-Preferred Brand	4	10	1	2	4	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 Diabetic Drugs												
H5577	042	0	1	01	01	H5577_042_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	042	0	1	01	01	H5577_042_0	4	Select Diabetic 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 Diabetic Drugs												
H5577	042	0	1	01	01	H5577_042_0	4	Select Diabetic 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 Diabetic Drugs										1		
H5577	043	0	1	01	01	H5577_043_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	043	0	1	01	01	H5577_043_0	4	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H5577	043	0	1	01	01	H5577_043_0	4	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 Diabetic Drugs												
H5577	043	0	1	01	01	H5577_043_0	4	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 Diabetic Drugs										1		3
H5577	043	0	1	01	01	H5577_043_0	4	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 Diabetic Drugs												
H5577	043	0	1	01	01	H5577_043_0	4	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 Diabetic Drugs												
H5577	043	0	1	01	01	H5577_043_0	4	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 Diabetic Drugs												
H5577	043	0	1	01	01	H5577_043_0	4	Select Diabetic 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 Diabetic Drugs												
H5577	043	0	1	01	01	H5577_043_0	4	Select Diabetic 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 Diabetic Drugs										1		
H5577	044	0	1	01	01	H5577_044_0	4	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 Diabetic Drugs												
H5577	044	0	1	01	01	H5577_044_0	4	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 Diabetic Drugs										1		
H5577	044	0	1	01	01	H5577_044_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				2	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, Select Diabetic Drugs												
H5577	044	0	1	01	01	H5577_044_0	4	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				2	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, Select Diabetic Drugs										1		3
H5577	044	0	1	01	01	H5577_044_0	4	Preferred Brand	4	10	1	2	3	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, Select Diabetic Drugs												
H5577	044	0	1	01	01	H5577_044_0	4	Non-Preferred Brand	4	10	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				54.69	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	044	0	1	01	01	H5577_044_0	4	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 Diabetic Drugs												
H5577	044	0	1	01	01	H5577_044_0	4	Select Diabetic Drugs	4	11	1	2	6	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 Diabetic Drugs												
H5577	044	0	1	01	01	H5577_044_0	4	Select Diabetic Drugs	4	11	1	2	6	3	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 Diabetic Drugs										1		
H5577	045	0	1	01	01	H5577_045_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	045	0	1	01	01	H5577_045_0	4	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H5577	045	0	1	01	01	H5577_045_0	4	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 Diabetic Drugs												
H5577	045	0	1	01	01	H5577_045_0	4	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 Diabetic Drugs										1		3
H5577	045	0	1	01	01	H5577_045_0	4	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 Diabetic Drugs												
H5577	045	0	1	01	01	H5577_045_0	4	Non-Preferred Brand	4	10	1	2	4	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 Diabetic Drugs												
H5577	045	0	1	01	01	H5577_045_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	045	0	1	01	01	H5577_045_0	4	Select Diabetic 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 Diabetic Drugs												
H5577	045	0	1	01	01	H5577_045_0	4	Select Diabetic 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 Diabetic Drugs										1		
H5590	005	0	1	01	01	H5590_005_0	4	Preferred Generic	4	11	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, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5590	005	0	1	01	01	H5590_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5590	007	0	1	01	01	H5590_007_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	007	0	1	01	01	H5590_007_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	007	0	1	01	01	H5590_007_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	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, Select Care Drugs												
H5590	007	0	1	01	01	H5590_007_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.11	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	007	0	1	01	01	H5590_007_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	007	0	1	01	01	H5590_007_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	008	0	1	01	01	H5590_008_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	008	0	1	01	01	H5590_008_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	008	0	1	01	01	H5590_008_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	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, Select Care Drugs												
H5590	008	0	1	01	01	H5590_008_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				96.31	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	008	0	1	01	01	H5590_008_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	008	0	1	01	01	H5590_008_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	009	0	1	01	01	H5590_009_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	009	0	1	01	01	H5590_009_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	009	0	1	01	01	H5590_009_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	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, Select Care Drugs												
H5590	009	0	1	01	01	H5590_009_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.48	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	009	0	1	01	01	H5590_009_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	009	0	1	01	01	H5590_009_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5591	005	0	1	02	01	H5591_005_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	4	1	02	01	H5591_006_4	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	4	1	02	01	H5591_006_4	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	4	1	02	01	H5591_006_4	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	4	1	02	01	H5591_006_4	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	5	1	02	01	H5591_006_5	6	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	5	1	02	01	H5591_006_5	6	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	5	1	02	01	H5591_006_5	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	5	1	02	01	H5591_006_5	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	5	1	02	01	H5591_006_5	6	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	5	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5591	007	0	1	01	01	H5591_007_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	5	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5591	007	0	1	01	01	H5591_007_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	28	28	28				600.00	28	28	28				28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	6	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	6	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	6	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	28	28	28				600.00	28	28	28				28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	1	1	02	01	H5591_015_1	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	1	1	02	01	H5591_015_1	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	1	1	02	01	H5591_015_1	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	1	1	02	01	H5591_015_1	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	1	1	02	01	H5591_015_1	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	2	1	02	01	H5591_015_2	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	2	1	02	01	H5591_015_2	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	2	1	02	01	H5591_015_2	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	2	1	02	01	H5591_015_2	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	2	1	02	01	H5591_015_2	5	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5593	001	0	1	01	01	H5593_001_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5593	001	0	1	01	01	H5593_001_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5593	001	0	1	01	01	H5593_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5593	001	0	1	01	01	H5593_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											42.29	25	25	25				41.89	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5593	001	0	1	01	01	H5593_001_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											533.98	25						340.51	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	7	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		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	7	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	7	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	001	0	1	01	01	H5594_001_0	7	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		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												
H5594	001	0	1	01	01	H5594_001_0	7	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	7	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		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	7	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	7	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	7	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	50.00		150.00																			50.00		100.00																50.00				50.00		1.67			1.67			1.47	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	7	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	8	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	10.00		30.00																			10.00		30.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	8	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	8	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	8	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	8	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	10.00		30.00																			10.00		30.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	8	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	8	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	8	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	8	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	8	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	8	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	8	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	8	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	7	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	7	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	7	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.44	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	7	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	55.00		165.00																			55.00		110.00																55.00				55.00		1.83			1.83			1.62	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	7	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		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	7	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	7	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	7	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	7	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	7	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.44	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	7	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	55.00		165.00																			55.00		110.00																55.00				55.00		1.83			1.83			1.62	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	7	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	030	0	1	01	01	H5594_030_0	7	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		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	7	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	7	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	7	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	7	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	7	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	8	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	8	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	8	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	8	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	8	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	7	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	7	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	7	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	7	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	7	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	8	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	8	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	8	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	8	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	9	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	9	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	9	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	9	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	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	001	0	1	01	01	H5599_001_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	001	0	1	01	01	H5599_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	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, Select Care Drugs												
H5599	001	0	1	01	01	H5599_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.39	33	33	33																								33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	001	0	1	01	01	H5599_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	001	0	1	01	01	H5599_001_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	002	0	1	02	01	H5599_002_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	002	0	1	02	01	H5599_002_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	002	0	1	02	01	H5599_002_0	5	Preferred Brand	4	11	1	1	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				78.19	22	22	22																								22	22	22				22	22	22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	002	0	1	02	01	H5599_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.14	37	37	37																								37	37	37				37	37	37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	002	0	1	02	01	H5599_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	002	0	1	02	01	H5599_002_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	003	0	1	01	01	H5599_003_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	003	0	1	01	01	H5599_003_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	003	0	1	01	01	H5599_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H5599	003	0	1	01	01	H5599_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.00	33	33	33																								33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	003	0	1	01	01	H5599_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	003	0	1	01	01	H5599_003_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	004	0	1	01	01	H5599_004_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	004	0	1	01	01	H5599_004_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	004	0	1	01	01	H5599_004_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H5599	004	0	1	01	01	H5599_004_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.89	44	44	44				93.44	42	42	42										44	44	44				42	42	42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	004	0	1	01	01	H5599_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	004	0	1	01	01	H5599_004_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	008	0	1	01	01	H5599_008_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	008	0	1	01	01	H5599_008_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	008	0	1	01	01	H5599_008_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H5599	008	0	1	01	01	H5599_008_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.39	33	33	33																								33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	008	0	1	01	01	H5599_008_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	008	0	1	01	01	H5599_008_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5608	002	0	1	01	01	H5608_002_0	9	Preferred Generic	4	01	1	2	1	1	111		10	100		1	30	60	100				1	2			100					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	9	Generic	4	01	1	2	2	1	111		10	100		1	30	60	100				1	2			100					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	9	Preferred Brand	4	10	1	1	3	1	111		10	100		1	30	60	100				1	2			100					10	31				33.92	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	9	Non-Preferred Brand	4	10	1	1	4	1	111		10	100		1	30	60	100				1	2			100					10	31				40.90	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	9	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				315.34	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	9	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	100				1	2			100					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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					2.00		6.00											15.00		45.00				2.00		0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	003	0	1	01	01	H5619_003_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	021	0	1	01	01	H5619_021_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	021	0	1	01	01	H5619_021_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	4	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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	046	0	1	01	01	H5619_046_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	046	0	1	01	01	H5619_046_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	046	0	1	01	01	H5619_046_0	7	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	047	0	1	01	01	H5619_047_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	01	01	H5619_049_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	01	01	H5619_049_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	01	01	H5619_049_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	01	01	H5619_049_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	01	01	H5619_049_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	01	01	H5619_051_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	01	01	H5619_051_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	01	01	H5619_051_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	01	01	H5619_051_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	01	01	H5619_051_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	01	01	H5619_053_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	01	01	H5619_053_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	01	01	H5619_053_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	01	01	H5619_053_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	01	01	H5619_053_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	054	0	1	01	01	H5619_054_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					3.00		9.00											5.00		15.00				3.00		0.00				5.00				5.00			0.17	0.10		0.17	0.10	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	054	0	1	01	01	H5619_054_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					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												
H5619	054	0	1	01	01	H5619_054_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	054	0	1	01	01	H5619_054_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	054	0	1	01	01	H5619_054_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	055	0	1	01	01	H5619_055_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	5	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					7.00		21.00											11.00		33.00				7.00		0.00				11.00				11.00			0.37	0.23		0.37	0.23	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	056	0	1	01	01	H5619_056_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	056	0	1	01	01	H5619_056_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	056	0	1	01	01	H5619_056_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	056	0	1	01	01	H5619_056_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	056	0	1	01	01	H5619_056_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	057	0	1	01	01	H5619_057_0	7	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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	057	0	1	01	01	H5619_057_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_0	6	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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	7	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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	061	0	1	01	01	H5619_061_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	062	0	1	01	01	H5619_062_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	062	0	1	01	01	H5619_062_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	062	0	1	01	01	H5619_062_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	062	0	1	01	01	H5619_062_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_063_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_063_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_063_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	064	0	1	01	01	H5619_064_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	064	0	1	01	01	H5619_064_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	064	0	1	01	01	H5619_064_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	064	0	1	01	01	H5619_064_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	064	0	1	01	01	H5619_064_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					4.00		12.00											19.00		57.00				4.00		0.00				19.00				19.00			0.63	0.13		0.63	0.13	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	069	0	1	01	01	H5619_069_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	069	0	1	01	01	H5619_069_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	069	0	1	01	01	H5619_069_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	073	0	1	01	01	H5619_073_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	073	0	1	01	01	H5619_073_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	073	0	1	01	01	H5619_073_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	073	0	1	01	01	H5619_073_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	075	0	1	01	01	H5619_075_0	7	Preferred Generic	4	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	075	0	1	01	01	H5619_075_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	075	0	1	01	01	H5619_075_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		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	7	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												
H5619	076	0	1	01	01	H5619_076_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	076	0	1	01	01	H5619_076_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		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	077	0	1	01	01	H5619_077_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	077	0	1	01	01	H5619_077_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	077	0	1	01	01	H5619_077_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	077	0	1	01	01	H5619_077_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	078	0	1	01	01	H5619_078_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	078	0	1	01	01	H5619_078_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	078	0	1	01	01	H5619_078_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	078	0	1	01	01	H5619_078_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	078	0	1	01	01	H5619_078_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	080	0	1	01	01	H5619_080_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	080	0	1	01	01	H5619_080_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	080	0	1	01	01	H5619_080_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	080	0	1	01	01	H5619_080_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	080	0	1	01	01	H5619_080_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	082	0	1	01	01	H5619_082_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	082	0	1	01	01	H5619_082_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	082	0	1	01	01	H5619_082_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	087	0	1	01	01	H5619_087_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	087	0	1	01	01	H5619_087_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	087	0	1	01	01	H5619_087_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	087	0	1	01	01	H5619_087_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	087	0	1	01	01	H5619_087_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	087	0	1	01	01	H5619_087_0	4	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	088	0	1	01	01	H5619_088_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	01	01	H5619_090_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	01	01	H5619_090_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	01	01	H5619_090_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	01	01	H5619_090_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	01	01	H5619_090_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	01	01	H5619_091_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	01	01	H5619_091_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	01	01	H5619_091_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	01	01	H5619_091_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	01	01	H5619_091_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	093	0	1	01	01	H5619_093_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	093	0	1	01	01	H5619_093_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	093	0	1	01	01	H5619_093_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	093	0	1	01	01	H5619_093_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	093	0	1	01	01	H5619_093_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_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												
H5619	094	0	1	01	01	H5619_094_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	01	01	H5619_095_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	01	01	H5619_095_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	01	01	H5619_095_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	01	01	H5619_095_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	01	01	H5619_095_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	097	0	1	01	01	H5619_097_0	8	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	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	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												32							32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	100	0	1	01	01	H5619_100_0	8	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	8	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	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	101	0	1	01	01	H5619_101_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	101	0	1	01	01	H5619_101_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	101	0	1	01	01	H5619_101_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	101	0	1	01	01	H5619_101_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	101	0	1	01	01	H5619_101_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												32							32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								14.00		42.00					5.00		15.00											14.00		42.00				5.00		0.00				14.00				14.00			0.47	0.17		0.47	0.17	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	01	01	H5619_111_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	01	01	H5619_111_0	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	01	01	H5619_111_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	01	01	H5619_111_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_114_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_114_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_114_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	115	0	1	01	01	H5619_115_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	115	0	1	01	01	H5619_115_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	115	0	1	01	01	H5619_115_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_0	4	Preferred Brand	4	11	1	2	3	1		110	01		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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	119	0	1	01	01	H5619_119_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	119	0	1	01	01	H5619_119_0	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	119	0	1	01	01	H5619_119_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	119	0	1	01	01	H5619_119_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	122	0	1	01	01	H5619_122_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	122	0	1	01	01	H5619_122_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	123	0	1	01	01	H5619_123_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	123	0	1	01	01	H5619_123_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	123	0	1	01	01	H5619_123_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	123	0	1	01	01	H5619_123_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	123	0	1	01	01	H5619_123_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	124	0	1	01	01	H5619_124_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	124	0	1	01	01	H5619_124_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	124	0	1	01	01	H5619_124_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	126	0	1	01	01	H5619_126_0	7	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												
H5619	126	0	1	01	01	H5619_126_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	126	0	1	01	01	H5619_126_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	126	0	1	01	01	H5619_126_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		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	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	128	0	1	01	01	H5619_128_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	128	0	1	01	01	H5619_128_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	128	0	1	01	01	H5619_128_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	1	1	01	01	H5619_130_1	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	1	1	01	01	H5619_130_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	1	1	01	01	H5619_130_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	1	1	01	01	H5619_130_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	1	1	01	01	H5619_130_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	2	1	01	01	H5619_130_2	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	2	1	01	01	H5619_130_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	2	1	01	01	H5619_130_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	2	1	01	01	H5619_130_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	2	1	01	01	H5619_130_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	131	0	1	01	01	H5619_131_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	131	0	1	01	01	H5619_131_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	131	0	1	01	01	H5619_131_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	131	0	1	01	01	H5619_131_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	133	0	1	01	01	H5619_133_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	133	0	1	01	01	H5619_133_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	133	0	1	01	01	H5619_133_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	133	0	1	01	01	H5619_133_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	133	0	1	01	01	H5619_133_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	134	0	1	01	01	H5619_134_0	7	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	134	0	1	01	01	H5619_134_0	7	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	134	0	1	01	01	H5619_134_0	7	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				29.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	134	0	1	01	01	H5619_134_0	7	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				27.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	134	0	1	01	01	H5619_134_0	7	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	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	1	1	01	01	H5619_136_1	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	1	1	01	01	H5619_136_1	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	1	1	01	01	H5619_136_1	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	1	1	01	01	H5619_136_1	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	1	1	01	01	H5619_136_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	2	1	01	01	H5619_136_2	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	2	1	01	01	H5619_136_2	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	Specialty Tier	4	11	1	1	5	1		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	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	3	1	01	01	H5619_136_3	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	3	1	01	01	H5619_136_3	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	3	1	01	01	H5619_136_3	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	3	1	01	01	H5619_136_3	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	4	1	01	01	H5619_136_4	7	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	7	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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	4	1	01	01	H5619_136_4	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	137	0	1	01	01	H5619_137_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	138	0	1	01	01	H5619_138_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	138	0	1	01	01	H5619_138_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	138	0	1	01	01	H5619_138_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	138	0	1	01	01	H5619_138_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	138	0	1	01	01	H5619_138_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	1	1	01	01	H5619_139_1	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	1	1	01	01	H5619_139_1	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	1	1	01	01	H5619_139_1	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	1	1	01	01	H5619_139_1	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	1	1	01	01	H5619_139_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	2	1	01	01	H5619_139_2	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	2	1	01	01	H5619_139_2	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	2	1	01	01	H5619_139_2	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	2	1	01	01	H5619_139_2	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	2	1	01	01	H5619_139_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	140	1	1	01	01	H5619_140_1	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	140	1	1	01	01	H5619_140_1	7	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	140	1	1	01	01	H5619_140_1	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	140	1	1	01	01	H5619_140_1	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	140	1	1	01	01	H5619_140_1	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	140	2	1	01	01	H5619_140_2	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	140	2	1	01	01	H5619_140_2	7	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	140	2	1	01	01	H5619_140_2	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	140	2	1	01	01	H5619_140_2	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	140	2	1	01	01	H5619_140_2	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	141	0	1	01	01	H5619_141_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	141	0	1	01	01	H5619_141_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	141	0	1	01	01	H5619_141_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	141	0	1	01	01	H5619_141_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	141	0	1	01	01	H5619_141_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	141	0	1	01	01	H5619_141_0	5	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	143	0	1	01	01	H5619_143_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	143	0	1	01	01	H5619_143_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	143	0	1	01	01	H5619_143_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	143	0	1	01	01	H5619_143_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	143	0	1	01	01	H5619_143_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	144	1	1	01	01	H5619_144_1	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	144	1	1	01	01	H5619_144_1	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	144	1	1	01	01	H5619_144_1	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	144	1	1	01	01	H5619_144_1	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	144	1	1	01	01	H5619_144_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	144	2	1	01	01	H5619_144_2	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	144	2	1	01	01	H5619_144_2	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	144	2	1	01	01	H5619_144_2	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	144	2	1	01	01	H5619_144_2	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	144	2	1	01	01	H5619_144_2	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	23.00	46.00	69.00																			23.00	46.00	69.00																23.00				23.00		0.74			0.74			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.53	39	39	39																		39	39	39															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				548.97	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	007	0	1	01	01	H5628_007_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	007	0	1	01	01	H5628_007_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	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	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	007	0	1	01	01	H5628_007_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				749.95	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	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	008	0	1	01	01	H5628_008_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	008	0	1	01	01	H5628_008_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	008	0	1	01	01	H5628_008_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	23.00	46.00	69.00																			23.00	46.00	69.00																23.00				23.00		0.74			0.74			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	008	0	1	01	01	H5628_008_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.33	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	008	0	1	01	01	H5628_008_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				704.24	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	009	0	1	01	01	H5628_009_0	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				898.22	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	6	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				941.57	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	6	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	011	0	1	01	01	H5628_011_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	011	0	1	01	01	H5628_011_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	011	0	1	01	01	H5628_011_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	23.00	46.00	69.00																			23.00	46.00	69.00																23.00				23.00		0.74			0.74			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	011	0	1	01	01	H5628_011_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.73	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	011	0	1	01	01	H5628_011_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				704.63	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	012	0	1	01	01	H5628_012_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	012	0	1	01	01	H5628_012_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	012	0	1	01	01	H5628_012_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	23.00	46.00	69.00																			23.00	46.00	69.00																23.00				23.00		0.74			0.74			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	012	0	1	01	01	H5628_012_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.64	38	38	38																		38	38	38															38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	012	0	1	01	01	H5628_012_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				550.60	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5644	002	0	1	01	01	H5644_002_0	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		12.00					2.00		5.00											5.00		12.00				2.00		0.00				2.00				2.00			0.17	0.07		0.17	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5644	002	0	1	01	01	H5644_002_0	8	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		37.00					8.00		20.00											15.00		37.00				8.00		0.00				8.00				8.00			0.50	0.27		0.50	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5644	002	0	1	01	01	H5644_002_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		117.00					42.00		105.00											47.00		117.00				42.00		105.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5644	002	0	1	01	01	H5644_002_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		250.00					95.00		237.00											100.00		250.00				95.00		237.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5644	002	0	1	01	01	H5644_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5649	001	0	1	01	01	H5649_001_0	6	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	001	0	1	01	01	H5649_001_0	6	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		3
H5649	001	0	1	01	01	H5649_001_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	001	0	1	01	01	H5649_001_0	6	Generic	4	11	1	2	2	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		
H5649	001	0	1	01	01	H5649_001_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				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 Diabetic Drugs												
H5649	001	0	1	01	01	H5649_001_0	6	Non-Preferred Drug	4	11	3	2	4	1	110		01	100		1	30		100				1	2			100				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 Diabetic Drugs												
H5649	001	0	1	01	01	H5649_001_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				692.91	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	001	0	1	01	01	H5649_001_0	6	Select Diabetic Drugs	4	10	1	2	6	1	110		01	100		1	30		100				1	2			100				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												
H5649	002	0	1	01	01	H5649_002_0	6	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	002	0	1	01	01	H5649_002_0	6	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		3
H5649	002	0	1	01	01	H5649_002_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	002	0	1	01	01	H5649_002_0	6	Generic	4	11	1	2	2	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		
H5649	002	0	1	01	01	H5649_002_0	6	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				141.49	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	002	0	1	01	01	H5649_002_0	6	Non-Preferred Drug	4	11	3	1	4	1	110		01	100		1	30		100				1	2			100				30		31				48.44	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	002	0	1	01	01	H5649_002_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				597.00	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	002	0	1	01	01	H5649_002_0	6	Select Diabetic Drugs	4	10	1	2	6	1	110		01	100		1	30		100				1	2			100				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												
H5649	004	0	1	01	01	H5649_004_0	6	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	004	0	1	01	01	H5649_004_0	6	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		3
H5649	004	0	1	01	01	H5649_004_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	004	0	1	01	01	H5649_004_0	6	Generic	4	11	1	2	2	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		
H5649	004	0	1	01	01	H5649_004_0	6	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				145.64	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	004	0	1	01	01	H5649_004_0	6	Non-Preferred Drug	4	11	3	1	4	1	110		01	100		1	30		100				1	2			100				30		31				50.59	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	004	0	1	01	01	H5649_004_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				635.72	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	004	0	1	01	01	H5649_004_0	6	Select Diabetic Drugs	4	10	1	2	6	1	110		01	100		1	30		100				1	2			100				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												
H5649	006	0	1	01	01	H5649_006_0	6	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	006	0	1	01	01	H5649_006_0	6	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		3
H5649	006	0	1	01	01	H5649_006_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	006	0	1	01	01	H5649_006_0	6	Generic	4	11	1	2	2	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		
H5649	006	0	1	01	01	H5649_006_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				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 Diabetic Drugs												
H5649	006	0	1	01	01	H5649_006_0	6	Non-Preferred Drug	4	11	3	2	4	1	110		01	100		1	30		100				1	2			100				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 Diabetic Drugs												
H5649	006	0	1	01	01	H5649_006_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				754.74	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	006	0	1	01	01	H5649_006_0	6	Select Diabetic Drugs	4	10	1	2	6	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	006	0	1	01	01	H5649_006_0	6	Select Diabetic Drugs	4	10	1	2	6	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		
H5649	008	0	1	01	01	H5649_008_0	6	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	008	0	1	01	01	H5649_008_0	6	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		3
H5649	008	0	1	01	01	H5649_008_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				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												
H5649	008	0	1	01	01	H5649_008_0	6	Generic	4	11	1	2	2	3	110		01	100		1	30		100				1	2			100				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		
H5649	008	0	1	01	01	H5649_008_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				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												
H5649	008	0	1	01	01	H5649_008_0	6	Non-Preferred Drug	4	11	3	2	4	1	110		01	100		1	30		100				1	2			100				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												
H5649	008	0	1	01	01	H5649_008_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				656.46	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	008	0	1	01	01	H5649_008_0	6	Select Diabetic Drugs	4	10	1	2	6	1	110		01	100		1	30		100				1	2			100				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												
H5649	009	0	1	01	01	H5649_009_0	6	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	009	0	1	01	01	H5649_009_0	6	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		3
H5649	009	0	1	01	01	H5649_009_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	009	0	1	01	01	H5649_009_0	6	Generic	4	11	1	2	2	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		
H5649	009	0	1	01	01	H5649_009_0	6	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				143.06	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	009	0	1	01	01	H5649_009_0	6	Non-Preferred Drug	4	11	3	1	4	1	110		01	100		1	30		100				1	2			100				30		31				50.07	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	009	0	1	01	01	H5649_009_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				739.92	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	009	0	1	01	01	H5649_009_0	6	Select Diabetic Drugs	4	10	1	2	6	1	110		01	100		1	30		100				1	2			100				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												
H5649	018	0	1	01	01	H5649_018_0	6	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	018	0	1	01	01	H5649_018_0	6	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		3
H5649	018	0	1	01	01	H5649_018_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				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												
H5649	018	0	1	01	01	H5649_018_0	6	Generic	4	11	1	2	2	3	110		01	100		1	30		100				1	2			100				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		
H5649	018	0	1	01	01	H5649_018_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				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 Diabetic Drugs												
H5649	018	0	1	01	01	H5649_018_0	6	Non-Preferred Drug	4	11	3	2	4	1	110		01	100		1	30		100				1	2			100				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 Diabetic Drugs												
H5649	018	0	1	01	01	H5649_018_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				670.93	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	018	0	1	01	01	H5649_018_0	6	Select Diabetic Drugs	4	10	1	2	6	1	110		01	100		1	30		100				1	2			100				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												
H5649	019	0	1	01	01	H5649_019_0	6	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		100				1	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, Select Diabetic Drugs												
H5649	019	0	1	01	01	H5649_019_0	6	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		100				1	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, Select Diabetic Drugs										1		3
H5649	019	0	1	01	01	H5649_019_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				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												
H5649	019	0	1	01	01	H5649_019_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				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												
H5649	019	0	1	01	01	H5649_019_0	6	Non-Preferred Drug	4	11	3	2	4	1	110		01	100		1	30		100				1	2			100				30		31	99.00		297.00																					198.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	019	0	1	01	01	H5649_019_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				692.86	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5649	019	0	1	01	01	H5649_019_0	6	Select Diabetic Drugs	4	10	1	2	6	1	110		01	100		1	30		100				1	2			100				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												
H5652	001	0	1	02	01	H5652_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5652	001	0	1	02	01	H5652_001_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5652	001	0	1	02	01	H5652_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				495.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	2	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		
H5652	003	0	1	02	01	H5652_003_0	2	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	2	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5652	003	0	1	02	01	H5652_003_0	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	28.00		84.00																											84.00						74.00				28.00				28.00		0.93						0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	70.00		210.00																											210.00						200.00				70.00				70.00		2.33						2.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				289.00	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	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	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5652	004	0	1	02	01	H5652_004_0	3	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	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	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	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	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												
H5652	006	0	1	02	01	H5652_006_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5652	006	0	1	02	01	H5652_006_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				219.00	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	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	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5652	008	0	1	02	01	H5652_008_0	3	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	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	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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				243.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5746	016	0	1	01	01	H5746_016_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					0.00	0.00	0.00																7.00				7.00			0.23	0.23	0.00			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	8	Preferred Brand	4	11	1	2	3	1		111	01	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	8	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H5746	018	0	1	01	01	H5746_018_0	8	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	018	0	1	01	01	H5746_018_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	018	0	1	01	01	H5746_018_0	8	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	8	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	019	0	1	01	01	H5746_019_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H5746	019	0	1	01	01	H5746_019_0	8	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	019	0	1	01	01	H5746_019_0	8	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	019	0	1	01	01	H5746_019_0	8	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	019	0	1	01	01	H5746_019_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	019	0	1	01	01	H5746_019_0	8	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	019	0	1	01	01	H5746_019_0	8	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	8	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												
H5774	005	0	1	01	01	H5774_005_0	8	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
H5774	005	0	1	01	01	H5774_005_0	8	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	8	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	8	Preferred Brand	4	10	3	2	3	1		110	01	100		1				30		90	1	2			90				30		31								30.00		60.00					0.00		0.00							0.00																30.00				0.00			1.00	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	8	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	8	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	8	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	8	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	8	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												
H5774	022	0	1	01	01	H5774_022_0	8	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
H5774	022	0	1	01	01	H5774_022_0	8	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	8	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	8	Preferred Brand	4	10	3	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	8	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	8	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	8	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	8	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	10	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	10	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	10	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	10	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	10	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	10	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	8	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	8	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	8	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	8	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	8	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	8	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								6.00		12.00					3.00		6.00							6.00																6.00				3.00			0.20	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	7	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								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	7	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	7	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	7	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	7	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	7	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	8	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												
H5774	027	0	1	02	01	H5774_027_0	8	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
H5774	027	0	1	02	01	H5774_027_0	8	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	8	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	8	Preferred Brand	4	10	3	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	027	0	1	02	01	H5774_027_0	8	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	8	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	8	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	8	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	9	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	9	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	9	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	9	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	9	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	9	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	031	0	1	02	01	H5774_031_0	8	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												
H5774	031	0	1	02	01	H5774_031_0	8	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
H5774	031	0	1	02	01	H5774_031_0	8	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	8	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	8	Preferred Brand	4	10	3	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					3.00		6.00							6.00																10.00				3.00			0.33	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5779	002	0	1	01	01	H5779_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	002	0	1	01	01	H5779_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	002	0	1	01	01	H5779_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H5779	002	0	1	01	01	H5779_002_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.80	49	49	49				95.72	47	47	47										49	49	49				47	47	47			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	002	0	1	01	01	H5779_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	002	0	1	01	01	H5779_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	005	0	1	01	01	H5779_005_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	005	0	1	01	01	H5779_005_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H5779	005	0	1	01	01	H5779_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5779	005	0	1	01	01	H5779_005_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.70	43	43	43				94.11	41	41	41										43	43	43				41	41	41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	005	0	1	01	01	H5779_005_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	005	0	1	01	01	H5779_005_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	006	0	1	01	01	H5779_006_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	006	0	1	01	01	H5779_006_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	006	0	1	01	01	H5779_006_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H5779	006	0	1	01	01	H5779_006_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				94.08	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	006	0	1	01	01	H5779_006_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	006	0	1	01	01	H5779_006_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	007	0	1	01	01	H5779_007_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	007	0	1	01	01	H5779_007_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5779	007	0	1	01	01	H5779_007_0	4	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					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												
H5779	007	0	1	01	01	H5779_007_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5779	007	0	1	01	01	H5779_007_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.60	40	40	40				94.62	38	38	38										40	40	40				38	38	38			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	007	0	1	01	01	H5779_007_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	007	0	1	01	01	H5779_007_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	007	0	1	01	01	H5779_007_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H5779	008	0	1	01	01	H5779_008_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	008	0	1	01	01	H5779_008_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	008	0	1	01	01	H5779_008_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	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, Select Care Drugs												
H5779	008	0	1	01	01	H5779_008_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.04	41	41	41																								41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	008	0	1	01	01	H5779_008_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	008	0	1	01	01	H5779_008_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5793	001	0	1	01	01	H5793_001_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	001	0	1	01	01	H5793_001_0	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	001	0	1	01	01	H5793_001_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											972.17	33						383.94	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	010	0	1	01	01	H5793_010_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5793	010	0	1	01	01	H5793_010_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	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					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												
H5793	010	0	1	01	01	H5793_010_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	010	0	1	01	01	H5793_010_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	010	0	1	01	01	H5793_010_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											958.34	33						642.37	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	014	0	1	01	01	H5793_014_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	014	0	1	01	01	H5793_014_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	014	0	1	01	01	H5793_014_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	014	0	1	01	01	H5793_014_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	014	0	1	01	01	H5793_014_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											838.77	28						425.99	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	015	0	1	01	01	H5793_015_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	015	0	1	01	01	H5793_015_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	015	0	1	01	01	H5793_015_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	015	0	1	01	01	H5793_015_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	015	0	1	01	01	H5793_015_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	015	0	1	01	01	H5793_015_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1047.16	33						411.68	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	016	0	1	01	01	H5793_016_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	016	0	1	01	01	H5793_016_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	016	0	1	01	01	H5793_016_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	016	0	1	01	01	H5793_016_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	016	0	1	01	01	H5793_016_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1003.17	33						433.93	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	017	0	1	02	01	H5793_017_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5793	017	0	1	02	01	H5793_017_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H5793	017	0	1	02	01	H5793_017_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	017	0	1	02	01	H5793_017_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											51.61	30	30	30				49.57	30	30	30										30	30	30				30	30	30				30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	017	0	1	02	01	H5793_017_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											613.88	25						401.75	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	018	0	1	01	01	H5793_018_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H5793	018	0	1	01	01	H5793_018_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		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	4	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					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												
H5793	018	0	1	01	01	H5793_018_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	018	0	1	01	01	H5793_018_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	018	0	1	01	01	H5793_018_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											834.80	28						430.78	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	5	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	5	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	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.30	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				660.07	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	013	0	1	01	01	H5810_013_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	013	0	1	01	01	H5810_013_0	5	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	5	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	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.52	31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	013	0	1	01	01	H5810_013_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				667.74	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	014	0	1	01	01	H5810_014_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5810	014	0	1	01	01	H5810_014_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5810	014	0	1	01	01	H5810_014_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5810	014	0	1	01	01	H5810_014_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5810	014	0	1	01	01	H5810_014_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				973.87	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5810	014	0	1	01	01	H5810_014_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5810	015	0	1	01	01	H5810_015_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.48			0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5810	015	0	1	01	01	H5810_015_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.65			0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5810	015	0	1	01	01	H5810_015_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5810	015	0	1	01	01	H5810_015_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5810	015	0	1	01	01	H5810_015_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				796.41	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5810	015	0	1	01	01	H5810_015_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	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 Drug, Specialty Tier, Select Care Drugs												
H5823	006	0	1	01	01	H5823_006_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	29.00	58.00	87.00																			29.00	58.00	87.00																29.00				29.00		0.94			0.94			0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.58	41	41	41																		41	41	41															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				797.13	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	010	0	1	01	01	H5823_010_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	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	010	0	1	01	01	H5823_010_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	010	0	1	01	01	H5823_010_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	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	010	0	1	01	01	H5823_010_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.80	41	41	41																		41	41	41															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	010	0	1	01	01	H5823_010_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				797.89	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	011	0	1	01	01	H5823_011_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5823	011	0	1	01	01	H5823_011_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5823	011	0	1	01	01	H5823_011_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5823	011	0	1	01	01	H5823_011_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5823	011	0	1	01	01	H5823_011_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				973.87	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5823	011	0	1	01	01	H5823_011_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5826	008	0	1	01	01	H5826_008_0	5	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											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												
H5826	008	0	1	01	01	H5826_008_0	5	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											15.00	30.00	30.00				10.00	20.00	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5	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											47.00	94.00	140.00				42.00	84.00	125.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31											71.74	50	50	50				77.12	50	50	50										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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							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	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											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												
H5826	009	0	1	01	01	H5826_009_0	5	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											15.00	30.00	30.00				10.00	20.00	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5	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											47.00	94.00	140.00				42.00	84.00	125.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31											62.66	50	50	50				57.97	50	50	50										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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	6	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											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												
H5826	010	0	1	01	01	H5826_010_0	6	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											15.00	30.00	30.00				10.00	20.00	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	6	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											47.00	94.00	140.00				42.00	84.00	125.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31											73.30	50	50	50				81.08	50	50	50										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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	016	0	1	01	01	H5826_016_0	5	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											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												
H5826	016	0	1	01	01	H5826_016_0	5	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											15.00	30.00	30.00				10.00	20.00	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	016	0	1	01	01	H5826_016_0	5	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											47.00	94.00	140.00				42.00	84.00	125.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	016	0	1	01	01	H5826_016_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31											73.32	50	50	50				62.19	50	50	50										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	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												
H5828	001	0	1	01	01	H5828_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								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												
H5828	001	0	1	01	01	H5828_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					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												
H5828	001	0	1	01	01	H5828_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					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	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	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												
H5828	001	0	1	01	01	H5828_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								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												
H5828	002	0	1	01	01	H5828_002_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H5828	002	0	1	01	01	H5828_002_0	7	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												
H5828	002	0	1	01	01	H5828_002_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	002	0	1	01	01	H5828_002_0	7	Select Care Drugs	4	01	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	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												
H5828	005	0	1	02	01	H5828_005_0	9	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	9	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					0.00	0.00	0.00																13.00				13.00			0.43	0.27	0.00			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	005	0	1	02	01	H5828_005_0	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	005	0	1	02	01	H5828_005_0	9	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	9	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	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	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					0.00	0.00	0.00																13.00				13.00			0.43	0.27	0.00			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	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	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	Specialty Tier	4	11	1	1	5	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	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	008	0	1	01	01	H5828_008_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	008	0	1	01	01	H5828_008_0	7	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					0.00	0.00	0.00																9.00				9.00			0.30	0.30	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	008	0	1	01	01	H5828_008_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	008	0	1	01	01	H5828_008_0	7	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	7	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	009	0	1	01	01	H5828_009_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	009	0	1	01	01	H5828_009_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	009	0	1	01	01	H5828_009_0	7	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	009	0	1	01	01	H5828_009_0	7	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	009	0	1	01	01	H5828_009_0	7	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												
H5828	009	0	1	01	01	H5828_009_0	7	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												
H5828	009	0	1	01	01	H5828_009_0	7	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												
H5828	009	0	1	01	01	H5828_009_0	7	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												
H5828	009	0	1	01	01	H5828_009_0	7	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	
H5843	001	0	1	01	01	H5843_001_0	12	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				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												
H5843	001	0	1	01	01	H5843_001_0	12	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		100				1	2			100				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		
H5843	001	0	1	01	01	H5843_001_0	12	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5843	001	0	1	01	01	H5843_001_0	12	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5843	001	0	1	01	01	H5843_001_0	12	Non-Preferred Drug	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 Drug, Specialty Tier												
H5843	001	0	1	01	01	H5843_001_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				909.96	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5843	002	0	1	01	01	H5843_002_0	12	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				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												
H5843	002	0	1	01	01	H5843_002_0	12	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		100				1	2			100				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		
H5843	002	0	1	01	01	H5843_002_0	12	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5843	002	0	1	01	01	H5843_002_0	12	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5843	002	0	1	01	01	H5843_002_0	12	Non-Preferred Drug	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 Drug, Specialty Tier												
H5843	002	0	1	01	01	H5843_002_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				909.93	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5843	004	0	1	01	01	H5843_004_0	12	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				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												
H5843	004	0	1	01	01	H5843_004_0	12	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		100				1	2			100				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		
H5843	004	0	1	01	01	H5843_004_0	12	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5843	004	0	1	01	01	H5843_004_0	12	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5843	004	0	1	01	01	H5843_004_0	12	Non-Preferred Drug	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 Drug, Specialty Tier												
H5843	004	0	1	01	01	H5843_004_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				909.97	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5843	005	0	1	01	01	H5843_005_0	12	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				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												
H5843	005	0	1	01	01	H5843_005_0	12	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		100				1	2			100				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		
H5843	005	0	1	01	01	H5843_005_0	12	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5843	005	0	1	01	01	H5843_005_0	12	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5843	005	0	1	01	01	H5843_005_0	12	Non-Preferred Drug	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 Drug, Specialty Tier												
H5843	005	0	1	01	01	H5843_005_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				909.75	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5852	001	0	1	01	01	H5852_001_0	4	Generic	4	01	1	1	1	1	110		01			1	30		100				1	2							30		34				4.68	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	Preferred Brand	4	11	1	1	2	1	110		01			1	30		100				1	2							30		34				72.91	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	Non-Preferred Brand	4	10	1	1	3	1	110		01			1	30		100				1	1							30		34				165.35	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	Specialty Tier	4	10	1	1	4	1	110		01			1	30		100				1	1							30		34				811.25	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	Select Care Drugs	4	01	1	1	5	1	110		01			1	30		100				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	Select Care Drugs	4	01	1	1	5	3	110		01			1	30		100				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	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			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	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			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	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	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	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	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	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					0.00	0.00	0.00																20.00				20.00			0.67	0.67	0.00			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	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	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	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	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	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	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			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	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			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	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	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	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	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	7	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					0.00	0.00	0.00																19.00				19.00			0.63	0.47	0.00			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	105.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	105.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H5854	010	0	1	01	01	H5854_010_0	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	7	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	7	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	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	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	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					0.00	0.00	0.00																8.00				8.00			0.27	0.27	0.00			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	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	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	011	0	1	01	01	H5854_011_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	011	0	1	01	01	H5854_011_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	12	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					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	012	0	1	02	01	H5854_012_0	12	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					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	012	0	1	02	01	H5854_012_0	12	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	12	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	12	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	12	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	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					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												
H5854	013	0	1	01	01	H5854_013_0	6	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	013	0	1	01	01	H5854_013_0	6	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	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	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	Select Care Drugs	4	01	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	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												
H5854	014	0	1	01	01	H5854_014_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	014	0	1	01	01	H5854_014_0	8	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	8	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	014	0	1	01	01	H5854_014_0	8	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	8	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	8	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	8	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	8	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	8	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	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	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	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					0.00	0.00	0.00																5.00				5.00			0.17	0.17	0.00			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	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	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	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	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	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		
H5883	002	1	1	02	01	H5883_002_1	8	Preferred Generic	4	01	1	2	1	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												
H5883	002	1	1	02	01	H5883_002_1	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	002	1	1	02	01	H5883_002_1	8	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												
H5883	002	1	1	02	01	H5883_002_1	8	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												
H5883	002	1	1	02	01	H5883_002_1	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											65.00	45		45				62.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	8	Preferred Generic	4	01	1	2	1	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												
H5883	002	2	1	02	01	H5883_002_2	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	002	2	1	02	01	H5883_002_2	8	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												
H5883	002	2	1	02	01	H5883_002_2	8	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												
H5883	002	2	1	02	01	H5883_002_2	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											65.00	45		45				62.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	8	Preferred Generic	4	01	1	2	1	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												
H5883	002	3	1	02	01	H5883_002_3	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	002	3	1	02	01	H5883_002_3	8	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												
H5883	002	3	1	02	01	H5883_002_3	8	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												
H5883	002	3	1	02	01	H5883_002_3	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											65.00	45		45				62.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	8	Preferred Generic	4	01	1	2	1	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												
H5883	002	4	1	02	01	H5883_002_4	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	002	4	1	02	01	H5883_002_4	8	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												
H5883	002	4	1	02	01	H5883_002_4	8	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												
H5883	002	4	1	02	01	H5883_002_4	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											65.00	45		45				62.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	8	Preferred Generic	4	01	1	2	1	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												
H5883	002	7	1	02	01	H5883_002_7	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	002	7	1	02	01	H5883_002_7	8	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												
H5883	002	7	1	02	01	H5883_002_7	8	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												
H5883	002	7	1	02	01	H5883_002_7	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											65.00	45		45				62.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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												
H5883	003	1	1	02	01	H5883_003_1	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	003	1	1	02	01	H5883_003_1	8	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												
H5883	003	1	1	02	01	H5883_003_1	8	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												
H5883	003	1	1	02	01	H5883_003_1	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											56.00	45		45				67.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	8	Preferred Generic	4	01	1	2	1	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												
H5883	003	2	1	02	01	H5883_003_2	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	003	2	1	02	01	H5883_003_2	8	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												
H5883	003	2	1	02	01	H5883_003_2	8	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												
H5883	003	2	1	02	01	H5883_003_2	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											56.00	45		45				67.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	8	Preferred Generic	4	01	1	2	1	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												
H5883	003	3	1	02	01	H5883_003_3	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	003	3	1	02	01	H5883_003_3	8	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												
H5883	003	3	1	02	01	H5883_003_3	8	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												
H5883	003	3	1	02	01	H5883_003_3	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											56.00	45		45				67.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	8	Preferred Generic	4	01	1	2	1	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												
H5883	003	4	1	02	01	H5883_003_4	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	003	4	1	02	01	H5883_003_4	8	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												
H5883	003	4	1	02	01	H5883_003_4	8	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												
H5883	003	4	1	02	01	H5883_003_4	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											56.00	45		45				67.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	8	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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												
H5883	003	5	1	02	01	H5883_003_5	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	003	5	1	02	01	H5883_003_5	8	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												
H5883	003	5	1	02	01	H5883_003_5	8	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												
H5883	003	5	1	02	01	H5883_003_5	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											56.00	45		45				67.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	8	Preferred Generic	4	01	1	2	1	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												
H5883	007	0	1	01	01	H5883_007_0	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	007	0	1	01	01	H5883_007_0	8	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												
H5883	007	0	1	01	01	H5883_007_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											57.00	48		48				56.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	1	1	02	01	H5883_012_1	8	Preferred Generic	4	01	1	2	1	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												
H5883	012	1	1	02	01	H5883_012_1	8	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					10.00		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	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					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	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											78.00	50		50				72.00	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	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	2	1	02	01	H5883_012_2	8	Preferred Generic	4	01	1	2	1	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												
H5883	012	2	1	02	01	H5883_012_2	8	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					10.00		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	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					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	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											78.00	50		50				72.00	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	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	1	1	02	01	H5883_014_1	8	Preferred Generic	4	01	1	2	1	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												
H5883	014	1	1	02	01	H5883_014_1	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	014	1	1	02	01	H5883_014_1	8	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												
H5883	014	1	1	02	01	H5883_014_1	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	1	1	02	01	H5883_014_1	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											100.00	50		50				87.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	1	1	02	01	H5883_014_1	8	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												
H5883	014	2	1	02	01	H5883_014_2	8	Preferred Generic	4	01	1	2	1	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												
H5883	014	2	1	02	01	H5883_014_2	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	014	2	1	02	01	H5883_014_2	8	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												
H5883	014	2	1	02	01	H5883_014_2	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	2	1	02	01	H5883_014_2	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											100.00	50		50				87.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	2	1	02	01	H5883_014_2	8	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												
H5883	014	3	1	02	01	H5883_014_3	8	Preferred Generic	4	01	1	2	1	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												
H5883	014	3	1	02	01	H5883_014_3	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	014	3	1	02	01	H5883_014_3	8	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												
H5883	014	3	1	02	01	H5883_014_3	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	3	1	02	01	H5883_014_3	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											100.00	50		50				87.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	3	1	02	01	H5883_014_3	8	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												
H5883	014	4	1	02	01	H5883_014_4	8	Preferred Generic	4	01	1	2	1	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												
H5883	014	4	1	02	01	H5883_014_4	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	014	4	1	02	01	H5883_014_4	8	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												
H5883	014	4	1	02	01	H5883_014_4	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	4	1	02	01	H5883_014_4	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											100.00	50		50				87.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	4	1	02	01	H5883_014_4	8	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												
H5883	014	5	1	02	01	H5883_014_5	8	Preferred Generic	4	01	1	2	1	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												
H5883	014	5	1	02	01	H5883_014_5	8	Preferred Generic	4	01	1	2	1	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										2		
H5883	014	5	1	02	01	H5883_014_5	8	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												
H5883	014	5	1	02	01	H5883_014_5	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	5	1	02	01	H5883_014_5	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											100.00	50		50				87.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	5	1	02	01	H5883_014_5	8	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												
H5900	001	0	1	04	01	H5900_001_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H5900	001	0	1	04	01	H5900_001_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	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												
H5900	001	0	1	04	01	H5900_001_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	74.00	139.00					47.00	72.00	109.00					49.00	74.00	111.00																47.00				47.00			1.57	1.57	1.63			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	001	0	1	04	01	H5900_001_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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												
H5900	001	0	1	04	01	H5900_001_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1143.14	33						1143.14	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	002	0	1	04	01	H5900_002_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H5900	002	0	1	04	01	H5900_002_0	7	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												
H5900	002	0	1	04	01	H5900_002_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								36.00	72.00	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												
H5900	002	0	1	04	01	H5900_002_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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												
H5900	002	0	1	04	01	H5900_002_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1128.66	33						1128.66	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	003	0	1	04	01	H5900_003_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	34.00					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												
H5900	003	0	1	04	01	H5900_003_0	6	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					10.00	20.00	22.00					8.00	16.00	0.00																18.00				10.00			0.60	0.33	0.27			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	003	0	1	04	01	H5900_003_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	139.00					47.00	94.00	109.00					37.00	74.00	111.00																47.00				47.00			1.57	1.57	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	003	0	1	04	01	H5900_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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												
H5900	003	0	1	04	01	H5900_003_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1133.67	33						1133.67	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	004	0	1	04	01	H5900_004_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					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												
H5900	004	0	1	04	01	H5900_004_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					10.00	20.00	20.00					8.00	16.00	0.00																14.00				10.00			0.47	0.33	0.27			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	004	0	1	04	01	H5900_004_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	139.00					47.00	94.00	109.00					37.00	74.00	111.00																47.00				47.00			1.57	1.57	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	004	0	1	04	01	H5900_004_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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												
H5900	004	0	1	04	01	H5900_004_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1133.74	33						1133.74	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.35			1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.10	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				641.42	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	005	0	1	01	01	H5926_005_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	005	0	1	01	01	H5926_005_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	005	0	1	01	01	H5926_005_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.35			1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	005	0	1	01	01	H5926_005_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.44	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	005	0	1	01	01	H5926_005_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				642.62	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	006	0	1	01	01	H5926_006_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5926	006	0	1	01	01	H5926_006_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5926	006	0	1	01	01	H5926_006_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5926	006	0	1	01	01	H5926_006_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5926	006	0	1	01	01	H5926_006_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				973.87	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5926	006	0	1	01	01	H5926_006_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5928	004	0	1	01	01	H5928_004_0	7	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	7	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	7	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	7	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	7	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				2	2			90				30		31				5.78	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	7	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				2	2			90				30		31				90.48	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	7	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				2	2			90				30		31				92.68	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	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				689.55	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	7	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	7	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	7	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	7	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	7	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				2	2			90				30		31				5.80	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	7	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				2	2			90				30		31				90.71	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	7	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				2	2			90				30		31				94.02	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	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				697.28	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	7	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	7	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	050	0	1	01	01	H5928_050_0	7	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	7	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											914.41	29						914.41	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	051	0	1	01	01	H5928_051_0	7	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	7	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	052	0	1	01	01	H5928_052_0	7	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	7	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	053	0	1	01	01	H5928_053_0	7	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	7	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	054	0	1	01	01	H5928_054_0	8	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	8	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	8	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				2	2			90				30		31				5.77	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	8	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				2	2			90				30		31				89.93	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	8	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				2	2			90				30		31				92.75	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				698.79	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_001_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_001_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	41.00	82.00	123.00																			41.00	82.00	123.00																41.00				41.00		1.37			1.37			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_001_0	8	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				74.72	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_001_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	009	0	1	01	01	H5932_009_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	009	0	1	01	01	H5932_009_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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	8	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				72.18	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	012	0	1	01	01	H5932_012_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	012	0	1	01	01	H5932_012_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	012	0	1	01	01	H5932_012_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	41.00	82.00	123.00																			41.00	82.00	123.00																41.00				41.00		1.37			1.37			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	012	0	1	01	01	H5932_012_0	8	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				68.64	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	012	0	1	01	01	H5932_012_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	013	0	1	01	01	H5932_013_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	013	0	1	01	01	H5932_013_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	013	0	1	01	01	H5932_013_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	013	0	1	01	01	H5932_013_0	8	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				71.37	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	013	0	1	01	01	H5932_013_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5938	001	0	1	01	01	H5938_001_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	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	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	001	0	1	01	01	H5938_001_0	6	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	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	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	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	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	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	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	6	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	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		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	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	6	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	6	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					3.00	6.00	0.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	008	0	1	01	01	H5938_008_0	7	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					7.00	14.00	21.00					7.00	14.00	17.50																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	008	0	1	01	01	H5938_008_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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, Select Care Drugs												
H5938	008	0	1	01	01	H5938_008_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					93.00	186.00	279.00					93.00	186.00	232.50																100.00				100.00			3.33	3.10	3.10			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	008	0	1	01	01	H5938_008_0	7	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31												33							33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	008	0	1	01	01	H5938_008_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	008	0	1	01	01	H5938_008_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5943	001	0	1	02	01	H5943_001_0	5	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	5	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	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											76.46	25	25	25				76.46	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											85.45	25	25	25				85.45	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	002	0	1	02	01	H5943_002_0	4	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	4	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											7.12	25	25	25				7.12	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	4	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											73.18	25	25	25				73.18	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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											86.35	25	25	25				86.35	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	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												
H5945	001	0	1	01	01	H5945_001_0	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	009	0	1	01	01	H5945_009_0	9	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	009	0	1	01	01	H5945_009_0	9	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	009	0	1	01	01	H5945_009_0	9	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	100				1	2			100				30		31				94.66	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	009	0	1	01	01	H5945_009_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				30		31	99.00	198.00	297.00																					297.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	009	0	1	01	01	H5945_009_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	009	0	1	01	01	H5945_009_0	9	Select Care Drugs	4	01	1	2	6	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												
H5959	009	0	1	04	01	H5959_009_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	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	009	0	1	04	01	H5959_009_0	4	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	009	0	1	04	01	H5959_009_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	009	0	1	04	01	H5959_009_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				94.30	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	009	0	1	04	01	H5959_009_0	4	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					28	28	28																		28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	1	1	04	01	H5959_010_1	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	1	1	04	01	H5959_010_1	4	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	9.00	18.00	18.00																			9.00	18.00	18.00																9.00				9.00		0.29			0.29			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	1	1	04	01	H5959_010_1	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	1	1	04	01	H5959_010_1	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				65.49	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	1	1	04	01	H5959_010_1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	2	1	04	01	H5959_010_2	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	2	1	04	01	H5959_010_2	4	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	9.00	18.00	18.00																			9.00	18.00	18.00																9.00				9.00		0.29			0.29			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	2	1	04	01	H5959_010_2	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	2	1	04	01	H5959_010_2	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				65.49	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	2	1	04	01	H5959_010_2	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	011	0	1	04	01	H5959_011_0	4	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	011	0	1	04	01	H5959_011_0	4	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	9.00	18.00	18.00																			9.00	18.00	18.00																9.00				9.00		0.29			0.29			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	011	0	1	04	01	H5959_011_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	011	0	1	04	01	H5959_011_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				60.16	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	011	0	1	04	01	H5959_011_0	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	012	0	1	04	01	H5959_012_0	3	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	3	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	3	Preferred Brand	4	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				90.98	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	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				90.98	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	3	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	1	1	04	01	H5959_013_1	3	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	3	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	3	Preferred Brand	4	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				90.98	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	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				94.83	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	3	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	2	1	04	01	H5959_013_2	3	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	3	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	3	Preferred Brand	4	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				90.98	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	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				94.83	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	3	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	1	1	04	01	H5959_014_1	3	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	014	1	1	04	01	H5959_014_1	3	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	1	1	04	01	H5959_014_1	3	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																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	1	1	04	01	H5959_014_1	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.90	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	1	1	04	01	H5959_014_1	3	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					28	28	28																		28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	2	1	04	01	H5959_014_2	3	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	014	2	1	04	01	H5959_014_2	3	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	2	1	04	01	H5959_014_2	3	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																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	2	1	04	01	H5959_014_2	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.90	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	2	1	04	01	H5959_014_2	3	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					28	28	28																		28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5965	001	0	1	04	01	H5965_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5965	001	0	1	04	01	H5965_001_0	5	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					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												
H5965	001	0	1	04	01	H5965_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H5965	001	0	1	04	01	H5965_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5965	001	0	1	04	01	H5965_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5965	001	0	1	04	01	H5965_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5965	002	0	1	04	01	H5965_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5965	002	0	1	04	01	H5965_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H5965	002	0	1	04	01	H5965_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H5965	002	0	1	04	01	H5965_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H5965	002	0	1	04	01	H5965_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5965	002	0	1	04	01	H5965_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5965	004	0	1	04	01	H5965_004_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5965	004	0	1	04	01	H5965_004_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	8.00	16.00	24.00																									8.00	16.00	24.00				8.00	16.00	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5965	004	0	1	04	01	H5965_004_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5965	004	0	1	04	01	H5965_004_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.63	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5965	004	0	1	04	01	H5965_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5965	004	0	1	04	01	H5965_004_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5970	001	0	1	04	01	H5970_001_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	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												
H5970	018	0	1	04	01	H5970_018_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	018	0	1	04	01	H5970_018_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	019	0	1	04	01	H5970_019_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	019	0	1	04	01	H5970_019_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	019	0	1	04	01	H5970_019_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	019	0	1	04	01	H5970_019_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	019	0	1	04	01	H5970_019_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					2.00		6.00											15.00		45.00				2.00		0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	020	0	1	04	01	H5970_020_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	020	0	1	04	01	H5970_020_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	020	0	1	04	01	H5970_020_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	1	1	04	01	H5970_024_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	1	1	04	01	H5970_024_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	2	1	04	01	H5970_024_2	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	2	1	04	01	H5970_024_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	025	0	1	04	01	H5970_025_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	025	0	1	04	01	H5970_025_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	025	0	1	04	01	H5970_025_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	025	0	1	04	01	H5970_025_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	025	0	1	04	01	H5970_025_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	026	0	1	04	01	H5970_026_0	5	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	026	0	1	04	01	H5970_026_0	5	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	026	0	1	04	01	H5970_026_0	5	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	026	0	1	04	01	H5970_026_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	026	0	1	04	01	H5970_026_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5989	011	0	1	01	01	H5989_011_0	6	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, Supplemental Drugs												
H5989	011	0	1	01	01	H5989_011_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	10.00																			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, Supplemental Drugs												
H5989	011	0	1	01	01	H5989_011_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	47.00																			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, Supplemental Drugs												
H5989	011	0	1	01	01	H5989_011_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H5989	011	0	1	01	01	H5989_011_0	6	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					26	26	26																		26	26	26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H5989	011	0	1	01	01	H5989_011_0	6	Supplemental Drugs	4	01	2	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H5989	011	0	1	01	01	H5989_011_0	6	Supplemental Drugs	4	01	2	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs										1		
H5991	003	0	1	01	01	H5991_003_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H5991	003	0	1	01	01	H5991_003_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.50		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5991	003	0	1	01	01	H5991_003_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H5991	003	0	1	01	01	H5991_003_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H5991	006	0	1	01	01	H5991_006_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.50		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	7	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H5991	006	0	1	01	01	H5991_006_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H5991	006	0	1	01	01	H5991_006_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	009	0	1	01	01	H5991_009_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H5991	009	0	1	01	01	H5991_009_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.50		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	009	0	1	01	01	H5991_009_0	6	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H5991	009	0	1	01	01	H5991_009_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	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												
H5991	009	0	1	01	01	H5991_009_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	001	0	1	01	01	H6062_001_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	001	0	1	01	01	H6062_001_0	7	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6062	001	0	1	01	01	H6062_001_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								20.00		60.00					15.00		30.00											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												
H6062	001	0	1	01	01	H6062_001_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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												
H6062	001	0	1	01	01	H6062_001_0	7	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	
H6062	001	0	1	01	01	H6062_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		100	1	1				30		100	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		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												
H6062	001	0	1	01	01	H6062_001_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	003	0	1	01	01	H6062_003_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	003	0	1	01	01	H6062_003_0	7	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6062	003	0	1	01	01	H6062_003_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								20.00		60.00					15.00		30.00											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												
H6062	003	0	1	01	01	H6062_003_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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												
H6062	003	0	1	01	01	H6062_003_0	7	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	
H6062	003	0	1	01	01	H6062_003_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		100	1	1				30		100	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		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												
H6062	003	0	1	01	01	H6062_003_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	005	0	1	01	01	H6062_005_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	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												
H6062	005	0	1	01	01	H6062_005_0	7	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	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										1		
H6062	005	0	1	01	01	H6062_005_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	005	0	1	01	01	H6062_005_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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												
H6062	005	0	1	01	01	H6062_005_0	7	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	
H6062	005	0	1	01	01	H6062_005_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		100	1	1				30		100	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		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												
H6062	005	0	1	01	01	H6062_005_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	006	0	1	01	01	H6062_006_0	8	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	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												
H6062	006	0	1	01	01	H6062_006_0	8	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	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										1		
H6062	006	0	1	01	01	H6062_006_0	8	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	006	0	1	01	01	H6062_006_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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												
H6062	006	0	1	01	01	H6062_006_0	8	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	
H6062	006	0	1	01	01	H6062_006_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		100	1	1				30		100	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		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												
H6062	006	0	1	01	01	H6062_006_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	1	1	01	01	H6067_001_1	9	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	9	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	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	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	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	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	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	2	1	01	01	H6067_001_2	9	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	9	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	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	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	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	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	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	1	1	01	01	H6067_002_1	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			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	8	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	8	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	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	2	1	01	01	H6067_002_2	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			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	8	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	8	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	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred 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	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H6121	003	0	1	01	01	H6121_003_0	5	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				7.67	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	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				92.08	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	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				50.21	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				577.11	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	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H6121	008	0	1	01	01	H6121_008_0	5	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	5	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H6121	008	0	1	01	01	H6121_008_0	5	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	8		24																					16																8				8		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	008	0	1	01	01	H6121_008_0	5	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	39		117																					78																39				39		1.30						1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	008	0	1	01	01	H6121_008_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	92		276																					184																92				92		3.07						2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	008	0	1	01	01	H6121_008_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				684.74	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	5	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	5	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H6154	001	0	1	02	01	H6154_001_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				0.00			0.50	0.00		0.50	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	001	0	1	02	01	H6154_001_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					14.00	28.00	42.00											20.00	40.00	60.00				14.00	28.00	32.00				20.00				14.00			0.67	0.47		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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				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	94.00	131.00				47.00				47.00			1.57	1.57		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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											96.41	41	41	41				100.57	41	41	41										41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	001	0	1	02	01	H6154_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	002	0	1	02	01	H6154_002_0	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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				4.00			0.50	0.13		0.50	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	002	0	1	02	01	H6154_002_0	8	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					14.00	28.00	42.00											20.00	40.00	60.00				14.00	28.00	0.00				20.00				14.00			0.67	0.47		0.67	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	002	0	1	02	01	H6154_002_0	8	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00			1.57	1.57		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	8	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											87.19	50	50	50				88.52	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	002	0	1	02	01	H6154_002_0	8	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												
H6154	003	0	1	01	01	H6154_003_0	7	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H6154	003	0	1	01	01	H6154_003_0	7	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				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	003	0	1	01	01	H6154_003_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	003	0	1	01	01	H6154_003_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				57.92	50	50	50																		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	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	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	004	0	1	01	01	H6154_004_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			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												
H6154	004	0	1	01	01	H6154_004_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H6154	004	0	1	01	01	H6154_004_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				63.31	50	50	50																		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	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												
H6158	001	0	1	01	01	H6158_001_0	5	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	5	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	001	0	1	01	01	H6158_001_0	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	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	5	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	5	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	5	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	002	0	1	01	01	H6158_002_0	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	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	5	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	5	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
H6193	001	0	1	01	01	H6193_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6193	001	0	1	01	01	H6193_001_0	5	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					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												
H6193	001	0	1	01	01	H6193_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H6193	001	0	1	01	01	H6193_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.10	47	47	47				94.88	45	45	45										47	47	47				45	45	45			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6193	001	0	1	01	01	H6193_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6193	001	0	1	01	01	H6193_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6202	001	0	1	04	01	H6202_001_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	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	Preferred Brand	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	Non-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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											896.67	28						896.67	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6202	002	0	1	04	01	H6202_002_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	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	Preferred Brand	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	Non-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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											941.09	30						941.09	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6229	005	0	1	48	05	H6229_005_0	3	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	3	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	3	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	3	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	3	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	3	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	9.85			0.00	9.85	0.00	9.85			
H6229	006	0	1	48	05	H6229_006_0	3	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	3	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	Preferred Generic	4	01	3	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					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												
H6237	007	1	1	01	01	H6237_007_1	7	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	60.00					12.00	24.00	36.00					12.00	24.00	0.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	1	1	01	01	H6237_007_1	7	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					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												
H6237	007	1	1	01	01	H6237_007_1	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1047.59	29						1047.59	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	2	1	01	01	H6237_007_2	8	Preferred Generic	4	01	3	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					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												
H6237	007	2	1	01	01	H6237_007_2	8	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	60.00					12.00	24.00	36.00					12.00	24.00	0.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	2	1	01	01	H6237_007_2	8	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					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												
H6237	007	2	1	01	01	H6237_007_2	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1047.59	29						1047.59	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	3	1	01	01	H6237_007_3	8	Preferred Generic	4	01	3	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					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												
H6237	007	3	1	01	01	H6237_007_3	8	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	60.00					12.00	24.00	36.00					12.00	24.00	0.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	3	1	01	01	H6237_007_3	8	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					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												
H6237	007	3	1	01	01	H6237_007_3	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1047.59	29						1047.59	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	1	1	01	01	H6237_008_1	7	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					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												
H6237	008	1	1	01	01	H6237_008_1	7	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					8.00	16.00	16.00					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												
H6237	008	1	1	01	01	H6237_008_1	7	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1119.84	31						1119.84	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	2	1	01	01	H6237_008_2	8	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					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												
H6237	008	2	1	01	01	H6237_008_2	8	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					8.00	16.00	16.00					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												
H6237	008	2	1	01	01	H6237_008_2	8	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	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1119.84	31						1119.84	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	3	1	01	01	H6237_008_3	7	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					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												
H6237	008	3	1	01	01	H6237_008_3	7	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					8.00	16.00	16.00					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												
H6237	008	3	1	01	01	H6237_008_3	7	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											77.68	45	45	45				69.05	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1119.84	31						1119.84	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	005	0	1	01	01	H6306_005_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	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	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	Preferred Brand	4	11	1	2	3	1	111		01	111		1	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	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	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	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				750.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	1	1	02	01	H6306_011_1	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	1	1	02	01	H6306_011_1	8	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	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	8	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	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	8	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				71.91	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	8	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				339.87	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	3	1	02	01	H6306_011_3	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	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	8	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	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	8	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	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	8	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				71.91	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	8	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				339.87	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	1	1	02	01	H6306_012_1	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			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												
H6306	012	1	1	02	01	H6306_012_1	8	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	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	8	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			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	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	8	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				648.44	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	5	1	02	01	H6306_012_5	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			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												
H6306	012	5	1	02	01	H6306_012_5	8	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	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	8	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			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	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	8	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				648.44	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	013	0	1	02	01	H6306_013_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			3.00	6.00	0.00																2.00				2.00		0.07			0.10			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	013	0	1	02	01	H6306_013_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			3.00	6.00	0.00																2.00				2.00		0.07			0.10			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6306	013	0	1	02	01	H6306_013_0	6	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																			10.00	20.00	0.00																8.00				8.00		0.27			0.33			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	013	0	1	02	01	H6306_013_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	6	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				881.70	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	014	0	1	02	01	H6306_014_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			3.00	6.00	0.00																2.00				2.00		0.07			0.10			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	014	0	1	02	01	H6306_014_0	6	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																			3.00	6.00	0.00																2.00				2.00		0.07			0.10			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6306	014	0	1	02	01	H6306_014_0	6	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																			10.00	20.00	0.00																8.00				8.00		0.27			0.33			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	014	0	1	02	01	H6306_014_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	014	0	1	02	01	H6306_014_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				63.85	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	6	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				935.03	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6316	001	0	1	01	01	H6316_001_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	001	0	1	01	01	H6316_001_0	7	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	7	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	001	0	1	01	01	H6316_001_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	001	0	1	01	01	H6316_001_0	7	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	7	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	8	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	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												
H6316	002	0	1	01	01	H6316_002_0	8	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												
H6316	002	0	1	01	01	H6316_002_0	8	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	120.00					40.00	120.00	120.00																40.00				40.00			1.33	1.33	1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	002	0	1	01	01	H6316_002_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	8	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												
H6316	002	0	1	01	01	H6316_002_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				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												
H6322	001	0	1	01	01	H6322_001_0	8	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	001	0	1	01	01	H6322_001_0	8	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6322	001	0	1	01	01	H6322_001_0	8	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	12.50	25.00	37.50																					28.13																12.50				12.50		0.42						0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	001	0	1	01	01	H6322_001_0	8	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																					105.75																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	001	0	1	01	01	H6322_001_0	8	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																					225.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	001	0	1	01	01	H6322_001_0	8	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				1400.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	001	0	1	01	01	H6322_001_0	8	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 Brand, Specialty Tier, Select Care Drugs												
H6322	002	0	1	01	01	H6322_002_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	002	0	1	01	01	H6322_002_0	9	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6322	002	0	1	01	01	H6322_002_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	12.50	25.00	37.50																					28.13																12.50				12.50		0.42						0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	002	0	1	01	01	H6322_002_0	9	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																					105.75																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	002	0	1	01	01	H6322_002_0	9	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																					225.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	002	0	1	01	01	H6322_002_0	9	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				1500.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	002	0	1	01	01	H6322_002_0	9	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 Brand, Specialty Tier, Select Care Drugs												
H6322	003	1	1	02	01	H6322_003_1	8	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	1	1	02	01	H6322_003_1	8	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6322	003	1	1	02	01	H6322_003_1	8	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	12.50	25.00	37.50																					28.13																12.50				12.50		0.42						0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	1	1	02	01	H6322_003_1	8	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																					105.75																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	1	1	02	01	H6322_003_1	8	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																					225.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	1	1	02	01	H6322_003_1	8	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				1500.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	1	1	02	01	H6322_003_1	8	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 Brand, Specialty Tier, Select Care Drugs												
H6322	003	2	1	02	01	H6322_003_2	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	2	1	02	01	H6322_003_2	9	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6322	003	2	1	02	01	H6322_003_2	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	12.50	25.00	37.50																					28.13																12.50				12.50		0.42						0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	2	1	02	01	H6322_003_2	9	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																					105.75																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	2	1	02	01	H6322_003_2	9	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																					225.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	2	1	02	01	H6322_003_2	9	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				1500.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	2	1	02	01	H6322_003_2	9	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 Brand, Specialty Tier, Select Care Drugs												
H6328	001	0	1	04	01	H6328_001_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6328	001	0	1	04	01	H6328_001_0	5	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	5	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			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	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	80.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	5	Preferred Brand	4	11	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	80.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6328	001	0	1	04	01	H6328_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	001	0	1	04	01	H6328_001_0	5	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				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	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	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												
H6328	002	0	1	04	01	H6328_002_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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										1		
H6328	002	0	1	04	01	H6328_002_0	5	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	5	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	24.00																			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	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	90.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	5	Preferred Brand	4	11	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	90.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6328	002	0	1	04	01	H6328_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H6328	002	0	1	04	01	H6328_002_0	5	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				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	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	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												
H6328	003	0	1	04	01	H6328_003_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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										1		
H6328	003	0	1	04	01	H6328_003_0	5	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	28.00	28.00																			14.00	28.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	5	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	28.00	28.00																			14.00	28.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6328	003	0	1	04	01	H6328_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	5	Preferred Brand	4	11	1	2	3	3	111		01	111		1	30	60	90				1	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										2	3	
H6328	003	0	1	04	01	H6328_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	200.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	5	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1586.85	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6348	002	0	1	04	01	H6348_002_0	3	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	002	0	1	04	01	H6348_002_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H6348	002	0	1	04	01	H6348_002_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H6348	002	0	1	04	01	H6348_002_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.73	46	46	46				94.43	44	44	44										46	46	46				44	44	44			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	002	0	1	04	01	H6348_002_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	002	0	1	04	01	H6348_002_0	3	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	10	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	2	2								10	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 Brand, Specialty Tier												
H6351	003	0	1	01	01	H6351_003_0	10	Generic	4	01	1	2	2	1		111	10			1				30	60	90	2	2								10	31								15.00	30.00	45.00					5.00	10.00	15.00																								15.00			15.00			0.50	0.17				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6351	003	0	1	01	01	H6351_003_0	10	Preferred Brand	4	10	1	2	3	1		111	10			1				30	60	90	2	2								10	31								45.00	90.00	135.00					35.00	70.00	105.00																								45.00			45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6351	003	0	1	01	01	H6351_003_0	10	Non-Preferred Brand	4	10	1	2	4	1		111	10			1				30	60	90	2	2								10	31								100.00	200.00	300.00					95.00	190.00	285.00																								100.00			100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6351	003	0	1	01	01	H6351_003_0	10	Specialty Tier	4	11	1	1	5	1		111	10			1				30	60	90	2	2								10	31												33	33	33					33	33	33																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6351	004	0	1	01	01	H6351_004_0	9	Preferred Generic	4	01	1	2	1	1		111	10			1				30	60	90	2	2								10	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 Brand, Specialty Tier, Select Diabetic Drugs												
H6351	004	0	1	01	01	H6351_004_0	9	Generic	4	01	1	2	2	1		111	10			1				30	60	90	2	2								10	31								15.00	30.00	45.00					5.00	10.00	15.00																								15.00			15.00			0.50	0.17				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H6351	004	0	1	01	01	H6351_004_0	9	Preferred Brand	4	10	1	2	3	1		111	10			1				30	60	90	2	2								10	31								45.00	90.00	135.00					35.00	70.00	105.00																								45.00			45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H6351	004	0	1	01	01	H6351_004_0	9	Non-Preferred Brand	4	10	1	2	4	1		111	10			1				30	60	90	2	2								10	31								100.00	200.00	300.00					95.00	190.00	285.00																								100.00			100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H6351	004	0	1	01	01	H6351_004_0	9	Specialty Tier	4	11	1	1	5	1		111	10			1				30	60	90	2	2								10	31												33	33	33					33	33	33																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H6351	004	0	1	01	01	H6351_004_0	9	Select Diabetic Drugs	4	11	1	2	6	1		111	10			1				30	60	90	2	2								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 Brand, Specialty Tier, Select Diabetic Drugs												
H6379	001	0	1	01	01	H6379_001_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	0.00					0.00	0.00	0.00											9.00	18.00	0.00				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												
H6379	001	0	1	01	01	H6379_001_0	5	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		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												
H6379	001	0	1	01	01	H6379_001_0	5	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	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	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											885.56	33	33	33				885.56	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	001	0	1	01	01	H6396_001_0	4	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	4	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	4	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	4	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	4	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	004	0	1	01	01	H6396_004_0	5	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	5	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	5	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	5	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	5	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	005	0	1	01	01	H6396_005_0	5	Preferred Generic	4	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	5	Generic	4	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	5	Preferred Brand	4	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	5	Non-Preferred Drug	4	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	5	Specialty Tier	4	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	011	0	1	01	01	H6396_011_0	4	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	4	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	4	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	4	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	4	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	012	0	1	01	01	H6396_012_0	5	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	5	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	5	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	5	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	5	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	013	0	1	01	01	H6396_013_0	5	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	5	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	5	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	5	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	5	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	014	0	1	01	01	H6396_014_0	5	Preferred Generic	4	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	5	Generic	4	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	5	Preferred Brand	4	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	5	Non-Preferred Drug	4	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	5	Specialty Tier	4	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	015	0	1	01	01	H6396_015_0	5	Preferred Generic	4	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	5	Generic	4	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	5	Preferred Brand	4	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	5	Non-Preferred Drug	4	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	5	Specialty Tier	4	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6399	001	0	1	01	01	H6399_001_0	3	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6399	001	0	1	01	01	H6399_001_0	3	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6399	001	0	1	01	01	H6399_001_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6399	001	0	1	01	01	H6399_001_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31				44.75	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6399	001	0	1	01	01	H6399_001_0	3	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				550.24	26																				26																		26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	001	0	1	01	01	H6446_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	001	0	1	01	01	H6446_001_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6446	001	0	1	01	01	H6446_001_0	4	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					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												
H6446	001	0	1	01	01	H6446_001_0	4	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	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										1		
H6446	001	0	1	01	01	H6446_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H6446	001	0	1	01	01	H6446_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6446	001	0	1	01	01	H6446_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	001	0	1	01	01	H6446_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H6446	003	0	1	01	01	H6446_003_0	4	Preferred Generic	4	11	3	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			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	003	0	1	01	01	H6446_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H6446	003	0	1	01	01	H6446_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H6446	003	0	1	01	01	H6446_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6446	003	0	1	01	01	H6446_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	003	0	1	01	01	H6446_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Preferred Generic	4	11	3	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			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	004	0	1	01	01	H6446_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H6446	004	0	1	01	01	H6446_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H6446	004	0	1	01	01	H6446_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6446	004	0	1	01	01	H6446_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	004	0	1	01	01	H6446_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Preferred Generic	4	11	3	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			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	005	0	1	01	01	H6446_005_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	005	0	1	01	01	H6446_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H6446	005	0	1	01	01	H6446_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6446	005	0	1	01	01	H6446_005_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	005	0	1	01	01	H6446_005_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	009	0	1	01	01	H6446_009_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6446	009	0	1	01	01	H6446_009_0	4	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					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												
H6446	009	0	1	01	01	H6446_009_0	4	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	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										1		
H6446	009	0	1	01	01	H6446_009_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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												
H6446	009	0	1	01	01	H6446_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6446	009	0	1	01	01	H6446_009_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	009	0	1	01	01	H6446_009_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H6446	010	0	1	01	01	H6446_010_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	010	0	1	01	01	H6446_010_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6446	010	0	1	01	01	H6446_010_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	010	0	1	01	01	H6446_010_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H6446	010	0	1	01	01	H6446_010_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6446	010	0	1	01	01	H6446_010_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	010	0	1	01	01	H6446_010_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H6446	011	0	1	01	01	H6446_011_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	011	0	1	01	01	H6446_011_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	011	0	1	01	01	H6446_011_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H6446	011	0	1	01	01	H6446_011_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.12	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	011	0	1	01	01	H6446_011_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	011	0	1	01	01	H6446_011_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	012	0	1	01	01	H6446_012_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	012	0	1	01	01	H6446_012_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	012	0	1	01	01	H6446_012_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H6446	012	0	1	01	01	H6446_012_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.12	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	012	0	1	01	01	H6446_012_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	012	0	1	01	01	H6446_012_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	013	0	1	01	01	H6446_013_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	013	0	1	01	01	H6446_013_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	013	0	1	01	01	H6446_013_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H6446	013	0	1	01	01	H6446_013_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.12	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	013	0	1	01	01	H6446_013_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	013	0	1	01	01	H6446_013_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	014	0	1	01	01	H6446_014_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	014	0	1	01	01	H6446_014_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	13.00	26.00	39.00																									13.00	26.00	39.00				13.00	26.00	0.00				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	014	0	1	01	01	H6446_014_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	014	0	1	01	01	H6446_014_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.21	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	014	0	1	01	01	H6446_014_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	014	0	1	01	01	H6446_014_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	015	0	1	01	01	H6446_015_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	015	0	1	01	01	H6446_015_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	13.00	26.00	39.00																									13.00	26.00	39.00				13.00	26.00	0.00				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	015	0	1	01	01	H6446_015_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	015	0	1	01	01	H6446_015_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.21	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	015	0	1	01	01	H6446_015_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	015	0	1	01	01	H6446_015_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	016	0	1	01	01	H6446_016_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	016	0	1	01	01	H6446_016_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	13.00	26.00	39.00																									13.00	26.00	39.00				13.00	26.00	0.00				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	016	0	1	01	01	H6446_016_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	016	0	1	01	01	H6446_016_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.21	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	016	0	1	01	01	H6446_016_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	016	0	1	01	01	H6446_016_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	017	0	1	01	01	H6446_017_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H6446	017	0	1	01	01	H6446_017_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2	2	3
H6446	017	0	1	01	01	H6446_017_0	4	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					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H6446	017	0	1	01	01	H6446_017_0	4	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	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H6446	017	0	1	01	01	H6446_017_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
H6446	017	0	1	01	01	H6446_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Diabetic Drugs												
H6446	017	0	1	01	01	H6446_017_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H6446	017	0	1	01	01	H6446_017_0	4	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H6446	017	0	1	01	01	H6446_017_0	4	Select Diabetic Drugs	4	10	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 Diabetic Drugs										2		
H6446	018	0	1	01	01	H6446_018_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H6446	018	0	1	01	01	H6446_018_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										2	2	3
H6446	018	0	1	01	01	H6446_018_0	4	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					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H6446	018	0	1	01	01	H6446_018_0	4	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	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H6446	018	0	1	01	01	H6446_018_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
H6446	018	0	1	01	01	H6446_018_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Diabetic Drugs												
H6446	018	0	1	01	01	H6446_018_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H6446	018	0	1	01	01	H6446_018_0	4	Select Diabetic Drugs	4	10	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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												
H6446	018	0	1	01	01	H6446_018_0	4	Select Diabetic Drugs	4	10	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 Diabetic Drugs										2		
H6453	005	0	1	01	01	H6453_005_0	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	9	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	9	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					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	9	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	9	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	9	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	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	9	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	9	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					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	9	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	9	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	9	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	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	9	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	9	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					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	9	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	9	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	9	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	10	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	10	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	10	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	10	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	10	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	10	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	10	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	10	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	10	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	10	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	10	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	10	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	10	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	10	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	10	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	10	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	10	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	10	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	10	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	10	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	10	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	10	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	10	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	10	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	10	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	10	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	10	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	10	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	10	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	10	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	11	Preferred Generic	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	11	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	11	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	11	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	11	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	11	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	10	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	10	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	10	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	10	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	10	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	10	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	002	0	1	04	01	H6502_002_0	12	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_0	12	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	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	12	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_0	12	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_0	12	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	004	0	1	04	01	H6502_004_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	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	004	0	1	04	01	H6502_004_0	8	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	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	004	0	1	04	01	H6502_004_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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	004	0	1	04	01	H6502_004_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	004	0	1	04	01	H6502_004_0	8	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	005	0	1	04	01	H6502_005_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	005	0	1	04	01	H6502_005_0	8	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	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	005	0	1	04	01	H6502_005_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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	005	0	1	04	01	H6502_005_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	005	0	1	04	01	H6502_005_0	8	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	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												
H6526	001	0	1	01	01	H6526_001_0	3	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		
H6526	001	0	1	01	01	H6526_001_0	3	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												
H6526	001	0	1	01	01	H6526_001_0	3	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
H6526	001	0	1	01	01	H6526_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	001	0	1	01	01	H6526_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	001	0	1	01	01	H6526_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				510.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	002	0	1	01	01	H6526_002_0	3	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												
H6526	002	0	1	01	01	H6526_002_0	3	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		
H6526	002	0	1	01	01	H6526_002_0	3	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												
H6526	002	0	1	01	01	H6526_002_0	3	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
H6526	002	0	1	01	01	H6526_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	002	0	1	01	01	H6526_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	002	0	1	01	01	H6526_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				569.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		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	006	0	1	04	01	H6528_006_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6528	006	0	1	04	01	H6528_006_0	3	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												
H6528	006	0	1	04	01	H6528_006_0	3	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
H6528	006	0	1	04	01	H6528_006_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				236.00	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	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	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		
H6528	031	0	1	04	01	H6528_031_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				319.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	033	0	1	04	01	H6528_033_0	5	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	033	0	1	04	01	H6528_033_0	5	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		
H6528	033	0	1	04	01	H6528_033_0	5	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	033	0	1	04	01	H6528_033_0	5	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6528	033	0	1	04	01	H6528_033_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												
H6528	033	0	1	04	01	H6528_033_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												
H6528	033	0	1	04	01	H6528_033_0	5	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												
H6528	035	0	1	04	01	H6528_035_0	3	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												
H6528	035	0	1	04	01	H6528_035_0	3	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		
H6528	035	0	1	04	01	H6528_035_0	3	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												
H6528	035	0	1	04	01	H6528_035_0	3	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
H6528	035	0	1	04	01	H6528_035_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	035	0	1	04	01	H6528_035_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	035	0	1	04	01	H6528_035_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				512.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6529	001	1	1	01	01	H6529_001_1	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					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	6	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	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					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	6	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	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	003	0	1	01	01	H6550_003_0	3	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	42.00				9.00	18.00	0.00				14.00				14.00			0.47	0.3		0.47	0.3	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	Preferred Brand	4	11	1	2	3	1		111	01		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												
H6550	003	0	1	01	01	H6550_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6550	003	0	1	01	01	H6550_003_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	003	0	1	01	01	H6550_003_0	3	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	3	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	004	0	1	01	01	H6550_004_0	3	Generic	4	11	1	2	2	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	4.00	0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	004	0	1	01	01	H6550_004_0	3	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	33.00	66.00	99.00																									33.00	66.00	99.00				33.00	66.00	66.00				33.00				33.00		1.1				1.1	1.1	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	004	0	1	01	01	H6550_004_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				92.13	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	004	0	1	01	01	H6550_004_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, Select Care Drugs												
H6550	004	0	1	01	01	H6550_004_0	3	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	006	0	1	01	01	H6550_006_0	3	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	006	0	1	01	01	H6550_006_0	3	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	006	0	1	01	01	H6550_006_0	3	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H6550	006	0	1	01	01	H6550_006_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.92	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	006	0	1	01	01	H6550_006_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, Select Care Drugs												
H6550	006	0	1	01	01	H6550_006_0	3	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	007	0	1	01	01	H6550_007_0	3	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	007	0	1	01	01	H6550_007_0	3	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	42.00				9.00	18.00	0.00				14.00				14.00			0.47	0.3		0.47	0.3	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	007	0	1	01	01	H6550_007_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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												
H6550	007	0	1	01	01	H6550_007_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6550	007	0	1	01	01	H6550_007_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, Select Care Drugs												
H6550	007	0	1	01	01	H6550_007_0	3	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	009	0	1	01	01	H6550_009_0	3	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	009	0	1	01	01	H6550_009_0	3	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	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												
H6550	009	0	1	01	01	H6550_009_0	3	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H6550	009	0	1	01	01	H6550_009_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.36	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	009	0	1	01	01	H6550_009_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, Select Care Drugs												
H6550	009	0	1	01	01	H6550_009_0	3	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	001	0	1	04	01	H6594_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	001	0	1	04	01	H6594_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H6594	001	0	1	04	01	H6594_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H6594	001	0	1	04	01	H6594_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.83	45	45	45				94.44	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	001	0	1	04	01	H6594_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	001	0	1	04	01	H6594_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	002	0	1	04	01	H6594_002_0	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	002	0	1	04	01	H6594_002_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H6594	002	0	1	04	01	H6594_002_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H6594	002	0	1	04	01	H6594_002_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											92.74	50	50	50				89.03	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	002	0	1	04	01	H6594_002_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	002	0	1	04	01	H6594_002_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	002	0	1	04	01	H6594_002_0	6	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H6594	003	0	1	04	01	H6594_003_0	7	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	003	0	1	04	01	H6594_003_0	7	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	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												
H6594	003	0	1	04	01	H6594_003_0	7	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H6594	003	0	1	04	01	H6594_003_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.67	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	003	0	1	04	01	H6594_003_0	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	003	0	1	04	01	H6594_003_0	7	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	004	0	1	04	01	H6594_004_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	004	0	1	04	01	H6594_004_0	6	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	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	004	0	1	04	01	H6594_004_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H6594	004	0	1	04	01	H6594_004_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.10	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	004	0	1	04	01	H6594_004_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	004	0	1	04	01	H6594_004_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6605	001	0	1	04	01	H6605_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6605	001	0	1	04	01	H6605_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6605	001	0	1	04	01	H6605_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H6605	001	0	1	04	01	H6605_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.43	45	45	45				95.01	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6605	001	0	1	04	01	H6605_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6605	001	0	1	04	01	H6605_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6605	003	0	1	04	01	H6605_003_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6605	003	0	1	04	01	H6605_003_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6605	003	0	1	04	01	H6605_003_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H6605	003	0	1	04	01	H6605_003_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.10	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6605	003	0	1	04	01	H6605_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6605	003	0	1	04	01	H6605_003_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	001	0	1	01	01	H6622_001_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	010	0	1	01	01	H6622_010_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	011	0	1	01	01	H6622_011_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	011	0	1	01	01	H6622_011_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	011	0	1	01	01	H6622_011_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	013	0	1	01	01	H6622_013_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	014	0	1	01	01	H6622_014_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_0	4	Preferred Generic	4	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	4	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												
H6622	015	0	1	01	01	H6622_015_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	017	0	1	01	01	H6622_017_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	5	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					7.00		21.00											11.00		33.00				7.00		0.00				11.00				11.00			0.37	0.23		0.37	0.23	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	018	0	1	01	01	H6622_018_0	4	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		0.27	0	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	018	0	1	01	01	H6622_018_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	018	0	1	01	01	H6622_018_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	01	01	H6622_021_1	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	021	1	1	01	01	H6622_021_1	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	01	01	H6622_021_1	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	01	01	H6622_021_1	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	Specialty Tier	4	11	1	1	5	1		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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	01	01	H6622_021_2	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	01	01	H6622_021_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	01	01	H6622_021_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	01	01	H6622_023_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	01	01	H6622_023_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	01	01	H6622_023_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	02	01	H6622_026_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	02	01	H6622_026_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	02	01	H6622_026_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	02	01	H6622_026_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	02	01	H6622_026_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	027	0	1	01	01	H6622_027_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					4.00		12.00											7.00		21.00				4.00		0.00				7.00				7.00			0.23	0.13		0.23	0.13	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	027	0	1	01	01	H6622_027_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	027	0	1	01	01	H6622_027_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	027	0	1	01	01	H6622_027_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	027	0	1	01	01	H6622_027_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_028_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_028_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_028_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_028_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	5	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	5	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	5	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	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	4	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H6622	030	0	1	01	01	H6622_030_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	4	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	030	0	1	01	01	H6622_030_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	030	0	1	01	01	H6622_030_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	030	0	1	01	01	H6622_030_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	4	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												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	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	032	0	1	01	01	H6622_032_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	034	0	1	01	01	H6622_034_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	035	0	1	01	01	H6622_035_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	036	0	1	01	01	H6622_036_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	036	0	1	01	01	H6622_036_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	036	0	1	01	01	H6622_036_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	037	0	1	01	01	H6622_037_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		260.00				100.00				100.00			3.33	3		3.33	3	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	048	0	1	01	01	H6622_048_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	048	0	1	01	01	H6622_048_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	048	0	1	01	01	H6622_048_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	048	0	1	01	01	H6622_048_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	049	0	1	01	01	H6622_049_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	051	0	1	01	01	H6622_051_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					5.00		15.00											19.00		57.00				5.00		0.00				19.00				19.00			0.63	0.17		0.63	0.17	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	051	0	1	01	01	H6622_051_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	051	0	1	01	01	H6622_051_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	051	0	1	01	01	H6622_051_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_055_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_055_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_055_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	01	01	H6622_060_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	01	01	H6622_060_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	01	01	H6622_060_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	01	01	H6622_060_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	061	0	1	01	01	H6622_061_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	063	0	1	01	01	H6622_063_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	063	0	1	01	01	H6622_063_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	064	0	1	01	01	H6622_064_0	9	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												
H6622	064	0	1	01	01	H6622_064_0	9	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	064	0	1	01	01	H6622_064_0	9	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				25.00	22		22										25		25				22		22			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	064	0	1	01	01	H6622_064_0	9	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	25		25				33.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	064	0	1	01	01	H6622_064_0	9	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	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	066	0	1	01	01	H6622_066_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	066	0	1	01	01	H6622_066_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	066	0	1	01	01	H6622_066_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	069	0	1	01	01	H6622_069_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	069	0	1	01	01	H6622_069_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	069	0	1	01	01	H6622_069_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	069	0	1	01	01	H6622_069_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	069	0	1	01	01	H6622_069_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	070	0	1	01	01	H6622_070_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	070	0	1	01	01	H6622_070_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	070	0	1	01	01	H6622_070_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	070	0	1	01	01	H6622_070_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	071	0	1	01	01	H6622_071_0	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	071	0	1	01	01	H6622_071_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	071	0	1	01	01	H6622_071_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	071	0	1	01	01	H6622_071_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	071	0	1	01	01	H6622_071_0	6	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	073	0	1	02	01	H6622_073_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	073	0	1	02	01	H6622_073_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	073	0	1	02	01	H6622_073_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	1	1	01	01	H6622_074_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	1	1	01	01	H6622_074_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	1	1	01	01	H6622_074_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	1	1	01	01	H6622_074_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	1	1	01	01	H6622_074_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	2	1	01	01	H6622_074_2	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	2	1	01	01	H6622_074_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	2	1	01	01	H6622_074_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	2	1	01	01	H6622_074_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	2	1	01	01	H6622_074_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	075	0	1	01	01	H6622_075_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	075	0	1	01	01	H6622_075_0	3	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	075	0	1	01	01	H6622_075_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	075	0	1	01	01	H6622_075_0	3	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	075	0	1	01	01	H6622_075_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	075	0	1	01	01	H6622_075_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	075	0	1	01	01	H6622_075_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	076	0	1	01	01	H6622_076_0	6	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	076	0	1	01	01	H6622_076_0	6	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	076	0	1	01	01	H6622_076_0	6	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	076	0	1	01	01	H6622_076_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	076	0	1	01	01	H6622_076_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	077	0	1	01	01	H6622_077_0	6	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	077	0	1	01	01	H6622_077_0	6	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	077	0	1	01	01	H6622_077_0	6	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	077	0	1	01	01	H6622_077_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	077	0	1	01	01	H6622_077_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	078	1	1	01	01	H6622_078_1	8	Preferred Generic	4	11	1	2	1	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		0.00				8.00				8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	078	1	1	01	01	H6622_078_1	8	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		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	078	1	1	01	01	H6622_078_1	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	078	1	1	01	01	H6622_078_1	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	078	1	1	01	01	H6622_078_1	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	078	2	1	01	01	H6622_078_2	7	Preferred Generic	4	11	1	2	1	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		0.00				8.00				8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	078	2	1	01	01	H6622_078_2	7	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												
H6622	078	2	1	01	01	H6622_078_2	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	078	2	1	01	01	H6622_078_2	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	078	2	1	01	01	H6622_078_2	7	Specialty Tier	4	11	1	1	5	1		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	079	0	1	01	01	H6622_079_0	4	Preferred Generic	4	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												
H6622	079	0	1	01	01	H6622_079_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	079	0	1	01	01	H6622_079_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	079	0	1	01	01	H6622_079_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	079	0	1	01	01	H6622_079_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												
H6672	003	0	1	01	01	H6672_003_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	5.00					0.00	0.00	0.00											5.00	10.00	5.00				0.00	0.00	0.00				0.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	003	0	1	01	01	H6672_003_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	50.00					15.00	30.00	37.50											20.00	40.00	50.00				15.00	30.00	37.50				15.00				15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	003	0	1	01	01	H6672_003_0	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	003	0	1	01	01	H6672_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	250.00					95.00	190.00	237.50											100.00	200.00	250.00				95.00	190.00	237.50				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	003	0	1	01	01	H6672_003_0	5	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											592.71	28	28	28				592.71	28	28	28										28	28	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	9	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								5.00	10.00	5.00					0.00	0.00	0.00											5.00	10.00	5.00				0.00	0.00	0.00				0.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	004	0	1	01	01	H6672_004_0	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	42.50					12.00	24.00	30.00											17.00	34.00	42.50				12.00	24.00	30.00				12.00				12.00			0.57	0.40		0.57	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	004	0	1	01	01	H6672_004_0	9	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	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	004	0	1	01	01	H6672_004_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	250.00					95.00	190.00	237.50											100.00	200.00	250.00				95.00	190.00	237.50				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	004	0	1	01	01	H6672_004_0	9	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											1006.77	33	33	33				1006.77	33	33	33										33	33	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	5	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								5.00	10.00	5.00					0.00	0.00	0.00											5.00	10.00	5.00				0.00	0.00	0.00				0.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	005	0	1	01	01	H6672_005_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	42.50					12.00	24.00	30.00											17.00	34.00	42.50				12.00	24.00	30.00				12.00				12.00			0.57	0.40		0.57	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	005	0	1	01	01	H6672_005_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	005	0	1	01	01	H6672_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	250.00					95.00	190.00	237.50											100.00	200.00	250.00				95.00	190.00	237.50				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	005	0	1	01	01	H6672_005_0	5	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											1019.33	33	33	33				1019.33	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6678	001	0	1	01	01	H6678_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	001	0	1	01	01	H6678_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	0.00				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	001	0	1	01	01	H6678_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H6678	001	0	1	01	01	H6678_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6678	001	0	1	01	01	H6678_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	001	0	1	01	01	H6678_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	002	0	1	01	01	H6678_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	002	0	1	01	01	H6678_002_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6678	002	0	1	01	01	H6678_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	002	0	1	01	01	H6678_002_0	4	Generic	4	11	1	2	2	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											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6678	002	0	1	01	01	H6678_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H6678	002	0	1	01	01	H6678_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6678	002	0	1	01	01	H6678_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	002	0	1	01	01	H6678_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	002	0	1	01	01	H6678_002_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H6678	003	0	1	01	01	H6678_003_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	003	0	1	01	01	H6678_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	0.00				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	003	0	1	01	01	H6678_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H6678	003	0	1	01	01	H6678_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6678	003	0	1	01	01	H6678_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, Select Care Drugs												
H6678	003	0	1	01	01	H6678_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	004	0	1	01	01	H6678_004_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	004	0	1	01	01	H6678_004_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6678	004	0	1	01	01	H6678_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	004	0	1	01	01	H6678_004_0	4	Generic	4	11	1	2	2	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											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6678	004	0	1	01	01	H6678_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H6678	004	0	1	01	01	H6678_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6678	004	0	1	01	01	H6678_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	004	0	1	01	01	H6678_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6678	004	0	1	01	01	H6678_004_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H6706	001	0	1	01	01	H6706_001_0	3	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												
H6706	001	0	1	01	01	H6706_001_0	3	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		
H6706	001	0	1	01	01	H6706_001_0	3	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	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	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	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	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												
H6713	001	0	1	04	01	H6713_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6713	001	0	1	04	01	H6713_001_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6713	001	0	1	04	01	H6713_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6713	001	0	1	04	01	H6713_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H6713	001	0	1	04	01	H6713_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6713	001	0	1	04	01	H6713_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6713	001	0	1	04	01	H6713_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6713	001	0	1	04	01	H6713_001_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H6713	002	0	1	04	01	H6713_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6713	002	0	1	04	01	H6713_002_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6713	002	0	1	04	01	H6713_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6713	002	0	1	04	01	H6713_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H6713	002	0	1	04	01	H6713_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6713	002	0	1	04	01	H6713_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6713	002	0	1	04	01	H6713_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6713	002	0	1	04	01	H6713_002_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H6723	001	1	1	01	01	H6723_001_1	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	9	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	1	1	01	01	H6723_001_1	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	1	1	01	01	H6723_001_1	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											76.56	50		50				76.53	50		50										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	9	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												
H6723	001	2	1	01	01	H6723_001_2	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	9	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	2	1	01	01	H6723_001_2	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	2	1	01	01	H6723_001_2	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											76.56	50		50				76.53	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	3	1	01	01	H6723_001_3	9	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	3	1	01	01	H6723_001_3	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	3	1	01	01	H6723_001_3	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	3	1	01	01	H6723_001_3	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	3	1	01	01	H6723_001_3	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											76.56	50		50				76.53	50		50										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	9	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												
H6723	002	1	1	01	01	H6723_002_1	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	1	1	01	01	H6723_002_1	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	1	1	01	01	H6723_002_1	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											76.16	50		50				76.87	50		50										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	9	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												
H6723	002	2	1	01	01	H6723_002_2	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	2	1	01	01	H6723_002_2	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	2	1	01	01	H6723_002_2	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											76.16	50		50				76.87	50		50										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	9	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												
H6723	002	3	1	01	01	H6723_002_3	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	3	1	01	01	H6723_002_3	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	3	1	01	01	H6723_002_3	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	3	1	01	01	H6723_002_3	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	3	1	01	01	H6723_002_3	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	3	1	01	01	H6723_002_3	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											76.16	50		50				76.87	50		50										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	9	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												
H6723	003	1	1	01	01	H6723_003_1	11	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	1	1	01	01	H6723_003_1	11	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	1	1	01	01	H6723_003_1	11	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	1	1	01	01	H6723_003_1	11	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	1	1	01	01	H6723_003_1	11	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	1	1	01	01	H6723_003_1	11	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											73.03	50		50				75.20	50		50										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	11	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												
H6723	003	2	1	01	01	H6723_003_2	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	2	1	01	01	H6723_003_2	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	2	1	01	01	H6723_003_2	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	2	1	01	01	H6723_003_2	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	2	1	01	01	H6723_003_2	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	2	1	01	01	H6723_003_2	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											73.03	50		50				75.20	50		50										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	9	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												
H6723	003	3	1	01	01	H6723_003_3	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	3	1	01	01	H6723_003_3	9	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											5.00		10.00				0.00		0.00				6.00				6.00			0.20	0.00		0.17	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	3	1	01	01	H6723_003_3	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	3	1	01	01	H6723_003_3	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	3	1	01	01	H6723_003_3	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	3	1	01	01	H6723_003_3	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											73.03	50		50				75.20	50		50										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	9	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												
H6723	005	1	1	01	01	H6723_005_1	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	1	1	01	01	H6723_005_1	9	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	005	1	1	01	01	H6723_005_1	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	1	1	01	01	H6723_005_1	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	005	1	1	01	01	H6723_005_1	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	1	1	01	01	H6723_005_1	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											72.44	50		50				76.95	50		50										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	9	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												
H6723	005	2	1	01	01	H6723_005_2	9	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	2	1	01	01	H6723_005_2	9	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								8.00		16.00					0.00		0.00											7.00		14.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	005	2	1	01	01	H6723_005_2	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	2	1	01	01	H6723_005_2	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					5.00		13.00											11.00		28.00				4.00		10.00				12.00				12.00			0.40	0.17		0.37	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	005	2	1	01	01	H6723_005_2	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	2	1	01	01	H6723_005_2	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											72.44	50		50				76.95	50		50										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	9	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												
H6723	006	1	1	01	01	H6723_006_1	9	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											11.00		28.00				3.00		7.00				12.00				12.00			0.40	0.13		0.37	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	9	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											11.00		28.00				3.00		7.00				12.00				12.00			0.40	0.13		0.37	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	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								16.00		40.00					8.00		20.00											15.00		38.00				6.00		15.00				16.00				16.00			0.53	0.27		0.50	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	1	1	01	01	H6723_006_1	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								16.00		40.00					8.00		20.00											15.00		38.00				6.00		15.00				16.00				16.00			0.53	0.27		0.50	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6723	006	1	1	01	01	H6723_006_1	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	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	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											72.01	50		50				71.33	50		50										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	9	Specialty Tier	4	11	1	1	5	1		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												
H6723	006	1	1	01	01	H6723_006_1	9	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											7.00		18.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	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	9	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											7.00		18.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	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	9	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											11.00		28.00				3.00		7.00				12.00				12.00			0.40	0.13		0.37	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	9	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											11.00		28.00				3.00		7.00				12.00				12.00			0.40	0.13		0.37	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	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								16.00		40.00					8.00		20.00											15.00		38.00				6.00		15.00				16.00				16.00			0.53	0.27		0.50	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	2	1	01	01	H6723_006_2	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								16.00		40.00					8.00		20.00											15.00		38.00				6.00		15.00				16.00				16.00			0.53	0.27		0.50	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6723	006	2	1	01	01	H6723_006_2	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	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	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											72.01	50		50				71.33	50		50										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	9	Specialty Tier	4	11	1	1	5	1		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												
H6723	006	2	1	01	01	H6723_006_2	9	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											7.00		18.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	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	9	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											7.00		18.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6723	006	3	1	01	01	H6723_006_3	9	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											11.00		28.00				3.00		7.00				12.00				12.00			0.40	0.13		0.37	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	3	1	01	01	H6723_006_3	9	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											11.00		28.00				3.00		7.00				12.00				12.00			0.40	0.13		0.37	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6723	006	3	1	01	01	H6723_006_3	9	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								16.00		40.00					8.00		20.00											15.00		38.00				6.00		15.00				16.00				16.00			0.53	0.27		0.50	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	3	1	01	01	H6723_006_3	9	Generic	4	01	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								16.00		40.00					8.00		20.00											15.00		38.00				6.00		15.00				16.00				16.00			0.53	0.27		0.50	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6723	006	3	1	01	01	H6723_006_3	9	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											45.00		130.00				40.00		110.00				47.00				47.00			1.57	1.40		1.50	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	3	1	01	01	H6723_006_3	9	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											72.01	50		50				71.33	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	3	1	01	01	H6723_006_3	9	Specialty Tier	4	11	1	1	5	1		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												
H6723	006	3	1	01	01	H6723_006_3	9	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											7.00		18.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	3	1	01	01	H6723_006_3	9	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											7.00		18.00				0.00		0.00				8.00				8.00			0.27	0.00		0.23	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	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	5	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	5	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	5	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	5	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	5	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	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	5	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	5	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	007	0	1	04	01	H6743_007_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		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	5	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1054.19	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	5	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	018	1	1	04	01	H6743_018_1	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	1	1	04	01	H6743_018_1	5	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	5	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	5	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	5	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	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	3	1	04	01	H6743_018_3	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	3	1	04	01	H6743_018_3	5	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	5	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	5	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	5	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	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	1	1	04	01	H6743_020_1	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	1	1	04	01	H6743_020_1	5	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	5	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	5	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	5	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	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	2	1	04	01	H6743_020_2	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	2	1	04	01	H6743_020_2	5	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	5	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	5	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	5	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	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	3	1	04	01	H6743_020_3	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	3	1	04	01	H6743_020_3	5	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	5	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	5	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	5	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	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	4	1	04	01	H6743_020_4	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	4	1	04	01	H6743_020_4	5	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	5	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	5	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	5	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	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	2	1	04	01	H6743_021_2	5	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	5	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	5	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	5	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	5	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	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	4	1	04	01	H6743_021_4	5	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	5	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	5	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	5	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	5	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	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6750	005	0	1	01	01	H6750_005_0	8	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	8	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	8	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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1495.50	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	012	1	1	01	01	H6750_012_1	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	037	0	1	01	01	H6815_037_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	037	0	1	01	01	H6815_037_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	037	0	1	01	01	H6815_037_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H6815	037	0	1	01	01	H6815_037_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.82	41	41	41																								41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	037	0	1	01	01	H6815_037_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	037	0	1	01	01	H6815_037_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	038	0	1	01	01	H6815_038_0	4	Preferred Generic	4	11	3	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			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	038	0	1	01	01	H6815_038_0	4	Preferred Generic	4	11	3	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, Select Care Drugs										1		3
H6815	038	0	1	01	01	H6815_038_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					8.00	16.00	24.00											15.00	30.00	45.00				8.00	16.00	0.00				15.00				15.00			0.5	0.27		0.5	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	038	0	1	01	01	H6815_038_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H6815	038	0	1	01	01	H6815_038_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6815	038	0	1	01	01	H6815_038_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	038	0	1	01	01	H6815_038_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	038	0	1	01	01	H6815_038_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H6830	001	0	1	04	01	H6830_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6830	001	0	1	04	01	H6830_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H6830	001	0	1	04	01	H6830_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H6830	001	0	1	04	01	H6830_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6830	001	0	1	04	01	H6830_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6830	001	0	1	04	01	H6830_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6830	002	0	1	04	01	H6830_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6830	002	0	1	04	01	H6830_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H6830	002	0	1	04	01	H6830_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H6830	002	0	1	04	01	H6830_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H6830	002	0	1	04	01	H6830_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6830	002	0	1	04	01	H6830_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6832	001	0	1	01	01	H6832_001_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	6.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6832	001	0	1	01	01	H6832_001_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			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												
H6832	001	0	1	01	01	H6832_001_0	5	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												
H6832	001	0	1	01	01	H6832_001_0	5	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												
H6832	001	0	1	01	01	H6832_001_0	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				797.12	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6832	002	0	1	01	01	H6832_002_0	5	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	6.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6832	002	0	1	01	01	H6832_002_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			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												
H6832	002	0	1	01	01	H6832_002_0	5	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												
H6832	002	0	1	01	01	H6832_002_0	5	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												
H6832	002	0	1	01	01	H6832_002_0	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				797.12	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6870	001	0	1	48	05	H6870_001_0	3	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6870	001	0	1	48	05	H6870_001_0	3	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6870	001	0	1	48	05	H6870_001_0	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6874	001	0	1	04	01	H6874_001_0	10	Preferred Generic	4	11	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	24.00				3.00	6.00	6.00					8.00			8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	001	0	1	04	01	H6874_001_0	10	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								18.00	32.00	54.00					12.00	24.00	36.00											18.00	32.00	54.00				12.00	24.00	24.00					18.00			18.00			0.60	0.40		0.60	0.40	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	001	0	1	04	01	H6874_001_0	10	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					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	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	001	0	1	04	01	H6874_001_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											60.00	50	50	50				60.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	001	0	1	04	01	H6874_001_0	10	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2515.00	27	27	27				2515.00	27	27	27										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	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	4.00					7.00			7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	002	0	1	04	01	H6874_002_0	8	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								16.00	32.00	48.00					10.00	20.00	30.00											16.00	32.00	48.00				10.00	20.00	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	8	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					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	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	002	0	1	04	01	H6874_002_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											65.00	50	50	50				65.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	002	0	1	04	01	H6874_002_0	8	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2291.00	27	27	27				2291.00	27	27	27										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	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				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	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					2.00	6.00	8.00																20.00				10.00			0.67	0.33	0.07			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	001	0	1	04	01	H6898_001_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	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	Non-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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											938.81	28						938.81	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	002	0	1	04	01	H6898_002_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					0.00	0.00	0.00					0.00	0.00	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	7	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					2.00	6.00	8.00																14.00				8.00			0.47	0.27	0.07			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	002	0	1	04	01	H6898_002_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								36.00	72.00	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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											977.82	30						977.82	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	001	0	1	01	01	H6910_001_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	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	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	Preferred Brand	4	11	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	Non-Preferred Drug	4	11	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											830.00	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	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	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	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	Preferred Brand	4	11	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	Non-Preferred Drug	4	11	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											830.00	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	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	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	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	Preferred Brand	4	11	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	Non-Preferred Drug	4	11	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											830.00	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	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				904.62	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	004	0	1	01	01	H6936_004_0	10	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	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	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	004	0	1	01	01	H6936_004_0	10	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	004	0	1	01	01	H6936_004_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1094.52	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	005	0	1	01	01	H6936_005_0	10	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	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	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				916.78	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	006	0	1	01	01	H6936_006_0	9	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	9	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	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	006	0	1	01	01	H6936_006_0	9	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	006	0	1	01	01	H6936_006_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1335.01	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6975	002	0	1	01	01	H6975_002_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	002	0	1	01	01	H6975_002_0	5	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	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	002	0	1	01	01	H6975_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H6975	002	0	1	01	01	H6975_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.91	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	002	0	1	01	01	H6975_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	002	0	1	01	01	H6975_002_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	003	0	1	01	01	H6975_003_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	003	0	1	01	01	H6975_003_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	003	0	1	01	01	H6975_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H6975	003	0	1	01	01	H6975_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.06	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	003	0	1	01	01	H6975_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	003	0	1	01	01	H6975_003_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	004	0	1	01	01	H6975_004_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	004	0	1	01	01	H6975_004_0	5	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	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	004	0	1	01	01	H6975_004_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H6975	004	0	1	01	01	H6975_004_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.91	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	004	0	1	01	01	H6975_004_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	004	0	1	01	01	H6975_004_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	005	0	1	01	01	H6975_005_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	005	0	1	01	01	H6975_005_0	5	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					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												
H6975	005	0	1	01	01	H6975_005_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H6975	005	0	1	01	01	H6975_005_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.60	44	44	44				94.12	42	42	42										44	44	44				42	42	42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	005	0	1	01	01	H6975_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	005	0	1	01	01	H6975_005_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6988	001	0	1	01	01	H6988_001_0	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	13	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	13	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	13	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	13	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	001	0	1	04	01	H7006_001_0	5	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	5	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	5	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	5	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	5	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	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	5	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	5	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	5	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	5	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	5	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	007	0	1	04	01	H7006_007_0	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	007	0	1	04	01	H7006_007_0	4	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												
H7006	007	0	1	04	01	H7006_007_0	4	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												
H7006	007	0	1	04	01	H7006_007_0	4	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												
H7006	007	0	1	04	01	H7006_007_0	4	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												
H7006	007	0	1	04	01	H7006_007_0	4	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	008	0	1	04	01	H7006_008_0	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	008	0	1	04	01	H7006_008_0	4	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												
H7006	008	0	1	04	01	H7006_008_0	4	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												
H7006	008	0	1	04	01	H7006_008_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		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												
H7006	008	0	1	04	01	H7006_008_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1270.96	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	008	0	1	04	01	H7006_008_0	4	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	009	0	1	04	01	H7006_009_0	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	009	0	1	04	01	H7006_009_0	4	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												
H7006	009	0	1	04	01	H7006_009_0	4	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												
H7006	009	0	1	04	01	H7006_009_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		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												
H7006	009	0	1	04	01	H7006_009_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1270.96	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	009	0	1	04	01	H7006_009_0	4	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	010	0	1	04	01	H7006_010_0	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	010	0	1	04	01	H7006_010_0	4	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												
H7006	010	0	1	04	01	H7006_010_0	4	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												
H7006	010	0	1	04	01	H7006_010_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		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												
H7006	010	0	1	04	01	H7006_010_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1270.96	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	010	0	1	04	01	H7006_010_0	4	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	011	0	1	04	01	H7006_011_0	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	011	0	1	04	01	H7006_011_0	4	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												
H7006	011	0	1	04	01	H7006_011_0	4	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												
H7006	011	0	1	04	01	H7006_011_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		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												
H7006	011	0	1	04	01	H7006_011_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1270.96	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	011	0	1	04	01	H7006_011_0	4	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	012	0	1	04	01	H7006_012_0	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	012	0	1	04	01	H7006_012_0	4	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												
H7006	012	0	1	04	01	H7006_012_0	4	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												
H7006	012	0	1	04	01	H7006_012_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		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												
H7006	012	0	1	04	01	H7006_012_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1270.96	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	012	0	1	04	01	H7006_012_0	4	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	013	0	1	04	01	H7006_013_0	4	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	013	0	1	04	01	H7006_013_0	4	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												
H7006	013	0	1	04	01	H7006_013_0	4	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												
H7006	013	0	1	04	01	H7006_013_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		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												
H7006	013	0	1	04	01	H7006_013_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1270.96	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	013	0	1	04	01	H7006_013_0	4	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7020	004	0	1	01	01	H7020_004_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					8.00	16.00	16.00											15.00	30.00	45.00				8.00	16.00	0.00				15.00				15.00			0.50	.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	004	0	1	01	01	H7020_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	004	0	1	01	01	H7020_004_0	4	Non-Preferred Drug	4	11	1	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											804.39	33						719.59	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	006	0	1	01	01	H7020_006_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	8.00											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												
H7020	006	0	1	01	01	H7020_006_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	006	0	1	01	01	H7020_006_0	4	Non-Preferred Drug	4	11	1	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.27	33						622.34	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	008	0	1	01	01	H7020_008_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					8.00	16.00	16.00											15.00	30.00	45.00				8.00	16.00	0.00				15.00				15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	008	0	1	01	01	H7020_008_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	008	0	1	01	01	H7020_008_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	008	0	1	01	01	H7020_008_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											804.36	33						719.59	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	001	0	1	04	01	H7063_001_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	3.00	3.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	001	0	1	04	01	H7063_001_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	3.00	3.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7063	001	0	1	04	01	H7063_001_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	5.00	5.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	001	0	1	04	01	H7063_001_0	7	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	10.00																			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		
H7063	001	0	1	04	01	H7063_001_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	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												
H7063	001	0	1	04	01	H7063_001_0	7	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		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	7	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	002	0	1	04	01	H7063_002_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	3.00	3.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	002	0	1	04	01	H7063_002_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	3.00	3.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7063	002	0	1	04	01	H7063_002_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	5.00	5.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	002	0	1	04	01	H7063_002_0	8	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	10.00																			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		
H7063	002	0	1	04	01	H7063_002_0	8	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H7063	002	0	1	04	01	H7063_002_0	8	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				100.00		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	8	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	006	0	1	04	01	H7063_006_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	3.00	3.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	006	0	1	04	01	H7063_006_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	3.00	3.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7063	006	0	1	04	01	H7063_006_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	5.00	5.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	006	0	1	04	01	H7063_006_0	7	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	10.00																			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		
H7063	006	0	1	04	01	H7063_006_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H7063	006	0	1	04	01	H7063_006_0	7	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		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	7	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	007	0	1	04	01	H7063_007_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	3.00	3.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	007	0	1	04	01	H7063_007_0	8	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	3.00	3.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7063	007	0	1	04	01	H7063_007_0	8	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	5.00	5.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	007	0	1	04	01	H7063_007_0	8	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	10.00																			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		
H7063	007	0	1	04	01	H7063_007_0	8	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	007	0	1	04	01	H7063_007_0	8	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				100.00		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	8	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	012	0	1	04	01	H7063_012_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	3.00	3.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	012	0	1	04	01	H7063_012_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	3.00	3.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7063	012	0	1	04	01	H7063_012_0	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	5.00	5.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	012	0	1	04	01	H7063_012_0	6	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	10.00																			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		
H7063	012	0	1	04	01	H7063_012_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	012	0	1	04	01	H7063_012_0	6	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				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	012	0	1	04	01	H7063_012_0	6	Specialty Tier	4	10	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												
H7074	001	0	1	04	01	H7074_001_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7074	001	0	1	04	01	H7074_001_0	7	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	15.00																			5.00	10.00	15.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7074	001	0	1	04	01	H7074_001_0	7	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7074	001	0	1	04	01	H7074_001_0	7	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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7074	001	0	1	04	01	H7074_001_0	7	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				935.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7074	001	0	1	04	01	H7074_001_0	7	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	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, Select Care Drugs												
H7074	001	0	1	04	01	H7074_001_0	7	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	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, Select Care Drugs										1		
H7076	015	0	1	01	01	H7076_015_0	5	Preferred Generic	4	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	5	Generic	4	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	5	Preferred Brand	4	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	5	Non-Preferred Drug	4	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	5	Specialty Tier	4	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												
H7076	015	0	1	01	01	H7076_015_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	016	0	1	01	01	H7076_016_0	5	Preferred Generic	4	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												
H7076	016	0	1	01	01	H7076_016_0	5	Generic	4	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												
H7076	016	0	1	01	01	H7076_016_0	5	Preferred Brand	4	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												
H7076	016	0	1	01	01	H7076_016_0	5	Non-Preferred Drug	4	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												
H7076	016	0	1	01	01	H7076_016_0	5	Specialty Tier	4	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												
H7076	016	0	1	01	01	H7076_016_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7093	002	0	1	04	01	H7093_002_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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, Select Care Drugs												
H7093	002	0	1	04	01	H7093_002_0	7	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7093	002	0	1	04	01	H7093_002_0	7	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												
H7093	002	0	1	04	01	H7093_002_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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												
H7093	002	0	1	04	01	H7093_002_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7093	002	0	1	04	01	H7093_002_0	7	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												
H7093	002	0	1	04	01	H7093_002_0	7	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		
H7115	001	0	1	01	01	H7115_001_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					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												
H7115	001	0	1	01	01	H7115_001_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	6	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	001	0	1	01	01	H7115_001_0	6	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	001	0	1	01	01	H7115_001_0	6	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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										1		
H7115	003	0	1	01	01	H7115_003_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					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												
H7115	003	0	1	01	01	H7115_003_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	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	8	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	003	0	1	01	01	H7115_003_0	8	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	8	Select Care Drugs	4	11	1	2	6	3		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										1		
H7115	004	0	1	01	01	H7115_004_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					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												
H7115	004	0	1	01	01	H7115_004_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	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	004	0	1	01	01	H7115_004_0	7	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	004	0	1	01	01	H7115_004_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	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	004	0	1	01	01	H7115_004_0	7	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												
H7115	004	0	1	01	01	H7115_004_0	7	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	004	0	1	01	01	H7115_004_0	7	Select Care Drugs	4	11	1	2	6	3		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										1		
H7123	001	0	1	01	01	H7123_001_0	8	Preferred Generic	2	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					5.00	7.50	10.00													15.00						10.00				10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7123	001	0	1	01	01	H7123_001_0	8	Generic	2	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	60.00					10.00	15.00	20.00													20.00						20.00				20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7123	001	0	1	01	01	H7123_001_0	8	Preferred Brand	2	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								40.00	80.00	120.00					19.00	28.50	38.00													43.00						38.00				40.00				19.00			1.33	0.63				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7123	001	0	1	01	01	H7123_001_0	8	Non-Preferred Drug	2	11	1	1	4	1		111	01		100	1				30	60	90	1	2						90	30		31											61.78	49	49	49				65.69	49	49	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	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											531.62	25						510.22	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	001	0	1	02	01	H7149_001_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	001	0	1	02	01	H7149_001_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H7149_001_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	001	0	1	02	01	H7149_001_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	02	01	H7149_001_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	001	0	1	02	01	H7149_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	001	0	1	02	01	H7149_001_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1165.67	33						439.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	004	0	1	02	01	H7149_004_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	004	0	1	02	01	H7149_004_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H7149_004_0	2	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					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												
H7149	004	0	1	02	01	H7149_004_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H7149_004_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	004	0	1	02	01	H7149_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	004	0	1	02	01	H7149_004_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											935.67	33						420.75	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	006	0	1	01	01	H7149_006_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H7149	006	0	1	01	01	H7149_006_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H7149	006	0	1	01	01	H7149_006_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	006	0	1	01	01	H7149_006_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											41.90	25	25	25				39.74	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	006	0	1	01	01	H7149_006_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											619.35	27						384.33	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	001	0	1	01	01	H7151_001_0	12	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												
H7151	001	0	1	01	01	H7151_001_0	12	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												
H7151	001	0	1	01	01	H7151_001_0	12	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										2	2	2
H7151	001	0	1	01	01	H7151_001_0	12	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												
H7151	001	0	1	01	01	H7151_001_0	12	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												
H7151	001	0	1	01	01	H7151_001_0	12	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				962.75	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	002	0	1	01	01	H7151_002_0	14	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												
H7151	002	0	1	01	01	H7151_002_0	14	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												
H7151	002	0	1	01	01	H7151_002_0	14	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										2	2	2
H7151	002	0	1	01	01	H7151_002_0	14	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				107.87	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	002	0	1	01	01	H7151_002_0	14	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				146.43	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	002	0	1	01	01	H7151_002_0	14	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				820.29	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	003	0	1	01	01	H7151_003_0	11	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												
H7151	003	0	1	01	01	H7151_003_0	11	Generic	4	11	3	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	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	003	0	1	01	01	H7151_003_0	11	Generic	4	11	3	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	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H7151	003	0	1	01	01	H7151_003_0	11	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												
H7151	003	0	1	01	01	H7151_003_0	11	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												
H7151	003	0	1	01	01	H7151_003_0	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1109.32	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7163	002	0	1	02	01	H7163_002_0	12	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	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 Brand, Specialty Tier												
H7163	002	0	1	02	01	H7163_002_0	12	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	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 Brand, Specialty Tier										1		
H7163	002	0	1	02	01	H7163_002_0	12	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								16.00		48.00					16.00		48.00													48.00						48.00				16.00				16.00			0.52	0.52				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	002	0	1	02	01	H7163_002_0	12	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												
H7163	002	0	1	02	01	H7163_002_0	12	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												
H7163	002	0	1	02	01	H7163_002_0	12	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1775.19	25						787.92	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	003	0	1	02	01	H7163_003_0	11	Preferred Generic	2	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												
H7163	003	0	1	02	01	H7163_003_0	11	Generic	2	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								10.00		30.00					10.00		30.00													30.00						30.00				10.00				10.00			0.32	0.32				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	003	0	1	02	01	H7163_003_0	11	Preferred Brand	2	10	1	1	3	1		110	01		100	1				31		100	1	2						100	31		31											118.91	25		25				119.55	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	11	Non-Preferred Brand	2	10	1	1	4	1		110	01		100	1				31		100	1	2						100	31		31											116.74	25		25				111.83	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	11	Specialty Tier	2	10	1	1	5	1		010	01		010	1				31								31			31		31											1500.61	25						633.07	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	004	0	1	02	01	H7163_004_0	12	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												
H7163	004	0	1	02	01	H7163_004_0	12	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		
H7163	004	0	1	02	01	H7163_004_0	12	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												
H7163	004	0	1	02	01	H7163_004_0	12	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												
H7163	004	0	1	02	01	H7163_004_0	12	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												
H7163	004	0	1	02	01	H7163_004_0	12	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1682.78	25						787.90	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7165	001	0	1	01	01	H7165_001_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	25.00				5.00	10.00	0.00				10.00				5.00			0.33	0.17		0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	001	0	1	01	01	H7165_001_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	25.00				5.00	10.00	0.00				10.00				5.00			0.33	0.17		0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7165	001	0	1	01	01	H7165_001_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	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												
H7165	001	0	1	01	01	H7165_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								44.00	88.00	132.00					37.00	74.00	111.00											44.00	88.00	110.00				37.00	74.00	92.50				44.00				37.00			1.47	1.23		1.47	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	001	0	1	01	01	H7165_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											65.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	001	0	1	01	01	H7165_001_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												31	31	31					31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	002	0	1	01	01	H7165_002_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	25.00				5.00	10.00	0.00				10.00				5.00			0.33	0.17		0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	002	0	1	01	01	H7165_002_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	25.00				5.00	10.00	0.00				10.00				5.00			0.33	0.17		0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7165	002	0	1	01	01	H7165_002_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	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												
H7165	002	0	1	01	01	H7165_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								44.00	88.00	132.00					37.00	74.00	111.00											44.00	88.00	110.00				37.00	74.00	92.50				44.00				37.00			1.47	1.23		1.47	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	002	0	1	01	01	H7165_002_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											65.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	002	0	1	01	01	H7165_002_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												31	31	31					31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7169	001	0	1	04	01	H7169_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7169	001	0	1	04	01	H7169_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H7169	001	0	1	04	01	H7169_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7169	001	0	1	04	01	H7169_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.32	45	45	45				94.90	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7169	001	0	1	04	01	H7169_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7169	001	0	1	04	01	H7169_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	001	0	1	01	01	H7173_001_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	001	0	1	01	01	H7173_001_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H7173	001	0	1	01	01	H7173_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.71	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	001	0	1	01	01	H7173_001_0	4	Specialty Tier	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												
H7173	001	0	1	01	01	H7173_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7173	002	0	1	01	01	H7173_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	5	Preferred Generic	4	11	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											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, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.5		0.67	0.5	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H7173	007	0	1	01	01	H7173_007_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	001	0	1	04	01	H7175_001_0	5	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					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												
H7175	001	0	1	04	01	H7175_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7175	001	0	1	04	01	H7175_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.57	50	50	50				90.78	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	001	0	1	04	01	H7175_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	001	0	1	04	01	H7175_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	002	0	1	04	01	H7175_002_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	002	0	1	04	01	H7175_002_0	6	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	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												
H7175	002	0	1	04	01	H7175_002_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H7175	002	0	1	04	01	H7175_002_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.45	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	002	0	1	04	01	H7175_002_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	002	0	1	04	01	H7175_002_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	003	0	1	04	01	H7175_003_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	003	0	1	04	01	H7175_003_0	6	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																									14.00	28.00	42.00				14.00	28.00	0.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	003	0	1	04	01	H7175_003_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H7175	003	0	1	04	01	H7175_003_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.04	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	003	0	1	04	01	H7175_003_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	003	0	1	04	01	H7175_003_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	004	0	1	04	01	H7175_004_0	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	004	0	1	04	01	H7175_004_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	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												
H7175	004	0	1	04	01	H7175_004_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7175	004	0	1	04	01	H7175_004_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7175	004	0	1	04	01	H7175_004_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	004	0	1	04	01	H7175_004_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	004	0	1	04	01	H7175_004_0	6	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H7175	006	0	1	04	01	H7175_006_0	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	006	0	1	04	01	H7175_006_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	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												
H7175	006	0	1	04	01	H7175_006_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7175	006	0	1	04	01	H7175_006_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.79	44	44	44				93.35	42	42	42										44	44	44				42	42	42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	006	0	1	04	01	H7175_006_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	006	0	1	04	01	H7175_006_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	007	0	1	04	01	H7175_007_0	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	007	0	1	04	01	H7175_007_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	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												
H7175	007	0	1	04	01	H7175_007_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H7175	007	0	1	04	01	H7175_007_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	297.00					89.00	178.00	267.00											99.00	198.00	297.00				89.00	178.00	178.00				99.00				99.00			3.3	2.97		3.3	2.97	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	007	0	1	04	01	H7175_007_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	007	0	1	04	01	H7175_007_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	7	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	7	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	7	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	7	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	7	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	7	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	6	Select Care Drugs	4	01	1	2	6	1	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	6	Select Care Drugs	4	01	1	2	6	1	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	6	Select Care Drugs	4	01	1	2	6	1	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	010	0	1	01	01	H7220_010_0	7	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	010	0	1	01	01	H7220_010_0	7	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	010	0	1	01	01	H7220_010_0	7	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	010	0	1	01	01	H7220_010_0	7	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	010	0	1	01	01	H7220_010_0	7	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	010	0	1	01	01	H7220_010_0	7	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	011	0	1	02	01	H7220_011_0	8	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	011	0	1	02	01	H7220_011_0	8	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	011	0	1	02	01	H7220_011_0	8	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	011	0	1	02	01	H7220_011_0	8	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	011	0	1	02	01	H7220_011_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	011	0	1	02	01	H7220_011_0	8	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	8	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	8	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	8	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												
H7245	002	0	1	01	01	H7245_002_0	7	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	002	0	1	01	01	H7245_002_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	7	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	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	Preferred Brand	4	11	1	2	3	1		111	01	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	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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												
H7245	003	0	1	01	01	H7245_003_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	005	0	1	01	01	H7245_005_0	7	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	005	0	1	01	01	H7245_005_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	001	0	1	04	01	H7273_001_0	12	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				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												
H7273	001	0	1	04	01	H7273_001_0	12	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		100				1	2			100				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		
H7273	001	0	1	04	01	H7273_001_0	12	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	001	0	1	04	01	H7273_001_0	12	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	001	0	1	04	01	H7273_001_0	12	Non-Preferred Drug	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 Drug, Specialty Tier												
H7273	001	0	1	04	01	H7273_001_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				909.94	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	002	0	1	04	01	H7273_002_0	12	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				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												
H7273	002	0	1	04	01	H7273_002_0	12	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		100				1	2			100				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		
H7273	002	0	1	04	01	H7273_002_0	12	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	002	0	1	04	01	H7273_002_0	12	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	002	0	1	04	01	H7273_002_0	12	Non-Preferred Drug	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 Drug, Specialty Tier												
H7273	002	0	1	04	01	H7273_002_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				909.97	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	004	0	1	04	01	H7273_004_0	12	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				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												
H7273	004	0	1	04	01	H7273_004_0	12	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		100				1	2			100				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		
H7273	004	0	1	04	01	H7273_004_0	12	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	004	0	1	04	01	H7273_004_0	12	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	004	0	1	04	01	H7273_004_0	12	Non-Preferred Drug	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 Drug, Specialty Tier												
H7273	004	0	1	04	01	H7273_004_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				912.01	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	005	0	1	04	01	H7273_005_0	12	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				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												
H7273	005	0	1	04	01	H7273_005_0	12	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		100				1	2			100				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		
H7273	005	0	1	04	01	H7273_005_0	12	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	005	0	1	04	01	H7273_005_0	12	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	005	0	1	04	01	H7273_005_0	12	Non-Preferred Drug	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 Drug, Specialty Tier												
H7273	005	0	1	04	01	H7273_005_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				911.08	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	006	0	1	04	01	H7284_006_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	006	0	1	04	01	H7284_006_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	006	0	1	04	01	H7284_006_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	006	0	1	04	01	H7284_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	006	0	1	04	01	H7284_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	007	0	1	04	01	H7284_007_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	007	0	1	04	01	H7284_007_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	007	0	1	04	01	H7284_007_0	4	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												
H7284	007	0	1	04	01	H7284_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	007	0	1	04	01	H7284_007_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	008	0	1	04	01	H7284_008_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	008	0	1	04	01	H7284_008_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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												
H7284	008	0	1	04	01	H7284_008_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	008	0	1	04	01	H7284_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	008	0	1	04	01	H7284_008_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	009	0	1	04	01	H7284_009_0	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	009	0	1	04	01	H7284_009_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	009	0	1	04	01	H7284_009_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	009	0	1	04	01	H7284_009_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												
H7284	009	0	1	04	01	H7284_009_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												
H7301	002	0	1	04	01	H7301_002_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	4	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7301	002	0	1	04	01	H7301_002_0	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	4	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7301	002	0	1	04	01	H7301_002_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	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												
H7301	002	0	1	04	01	H7301_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H7301	002	0	1	04	01	H7301_002_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1135.88	33						880.89	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	4	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	4	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7301	006	0	1	04	01	H7301_006_0	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	4	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7301	006	0	1	04	01	H7301_006_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	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												
H7301	006	0	1	04	01	H7301_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
H7301	006	0	1	04	01	H7301_006_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1003.75	33						704.43	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											987.90	33						557.94	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	009	0	1	04	01	H7301_009_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	009	0	1	04	01	H7301_009_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	009	0	1	04	01	H7301_009_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	009	0	1	04	01	H7301_009_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	009	0	1	04	01	H7301_009_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											827.93	33						560.72	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	011	0	1	04	01	H7301_011_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	011	0	1	04	01	H7301_011_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	011	0	1	04	01	H7301_011_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	011	0	1	04	01	H7301_011_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	011	0	1	04	01	H7301_011_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	011	0	1	04	01	H7301_011_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	011	0	1	04	01	H7301_011_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											934.02	33						442.83	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	012	0	1	04	01	H7301_012_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	012	0	1	04	01	H7301_012_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	012	0	1	04	01	H7301_012_0	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	012	0	1	04	01	H7301_012_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	012	0	1	04	01	H7301_012_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	012	0	1	04	01	H7301_012_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	012	0	1	04	01	H7301_012_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											934.02	33						442.83	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7322	001	0	1	01	01	H7322_001_0	7	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		90				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	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7322	001	0	1	01	01	H7322_001_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				903.54	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7322	002	0	1	01	01	H7322_002_0	7	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		90				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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1005.12	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	001	0	1	04	01	H7323_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	001	0	1	04	01	H7323_001_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7323	001	0	1	04	01	H7323_001_0	4	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					1.00	2.00	3.00											5.00	10.00	15.00				1.00	2.00	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, Select Care Drugs												
H7323	001	0	1	04	01	H7323_001_0	4	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	15.00					1.00	2.00	3.00											5.00	10.00	15.00				1.00	2.00	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, Select Care Drugs										1		
H7323	001	0	1	04	01	H7323_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H7323	001	0	1	04	01	H7323_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.05	44	44	44				93.59	42	42	42										44	44	44				42	42	42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	001	0	1	04	01	H7323_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	001	0	1	04	01	H7323_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	001	0	1	04	01	H7323_001_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H7323	002	0	1	04	01	H7323_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	002	0	1	04	01	H7323_002_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7323	002	0	1	04	01	H7323_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H7323	002	0	1	04	01	H7323_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H7323	002	0	1	04	01	H7323_002_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.62	43	43	43				94.99	41	41	41										43	43	43				41	41	41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	002	0	1	04	01	H7323_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	002	0	1	04	01	H7323_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	002	0	1	04	01	H7323_002_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H7323	003	0	1	04	01	H7323_003_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	003	0	1	04	01	H7323_003_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7323	003	0	1	04	01	H7323_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	003	0	1	04	01	H7323_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H7323	003	0	1	04	01	H7323_003_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.19	43	43	43				93.62	41	41	41										43	43	43				41	41	41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	003	0	1	04	01	H7323_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	003	0	1	04	01	H7323_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	003	0	1	04	01	H7323_003_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H7323	004	0	1	04	01	H7323_004_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	004	0	1	04	01	H7323_004_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7323	004	0	1	04	01	H7323_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	004	0	1	04	01	H7323_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H7323	004	0	1	04	01	H7323_004_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.99	42	42	42				93.33	40	40	40										42	42	42				40	40	40			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	004	0	1	04	01	H7323_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	004	0	1	04	01	H7323_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	004	0	1	04	01	H7323_004_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H7323	005	0	1	04	01	H7323_005_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	005	0	1	04	01	H7323_005_0	4	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	15.00				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												
H7323	005	0	1	04	01	H7323_005_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H7323	005	0	1	04	01	H7323_005_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.57	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	005	0	1	04	01	H7323_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	005	0	1	04	01	H7323_005_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	006	0	1	04	01	H7323_006_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	006	0	1	04	01	H7323_006_0	4	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					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												
H7323	006	0	1	04	01	H7323_006_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H7323	006	0	1	04	01	H7323_006_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.16	44	44	44				93.70	42	42	42										44	44	44				42	42	42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	006	0	1	04	01	H7323_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	006	0	1	04	01	H7323_006_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	007	0	1	04	01	H7323_007_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	007	0	1	04	01	H7323_007_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7323	007	0	1	04	01	H7323_007_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	007	0	1	04	01	H7323_007_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	50.00				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												
H7323	007	0	1	04	01	H7323_007_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.84	45	45	45				94.45	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	007	0	1	04	01	H7323_007_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	007	0	1	04	01	H7323_007_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	007	0	1	04	01	H7323_007_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H7326	001	0	1	04	01	H7326_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7326	001	0	1	04	01	H7326_001_0	5	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					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												
H7326	001	0	1	04	01	H7326_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7326	001	0	1	04	01	H7326_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7326	001	0	1	04	01	H7326_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7326	001	0	1	04	01	H7326_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7326	001	0	1	04	01	H7326_001_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H7326	002	0	1	04	01	H7326_002_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7326	002	0	1	04	01	H7326_002_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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, Select Care Drugs												
H7326	002	0	1	04	01	H7326_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7326	002	0	1	04	01	H7326_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.38	42	42	42				93.70	40	40	40										42	42	42				40	40	40			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7326	002	0	1	04	01	H7326_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7326	002	0	1	04	01	H7326_002_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7326	003	0	1	04	01	H7326_003_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7326	003	0	1	04	01	H7326_003_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7326	003	0	1	04	01	H7326_003_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7326	003	0	1	04	01	H7326_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7326	003	0	1	04	01	H7326_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7326	003	0	1	04	01	H7326_003_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7326	003	0	1	04	01	H7326_003_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H7330	001	0	1	01	01	H7330_001_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7330	001	0	1	01	01	H7330_001_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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		
H7330	001	0	1	01	01	H7330_001_0	8	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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 Brand, Specialty Tier												
H7330	001	0	1	01	01	H7330_001_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7330	001	0	1	01	01	H7330_001_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7330	001	0	1	01	01	H7330_001_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7330	002	0	1	02	01	H7330_002_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7330	002	0	1	02	01	H7330_002_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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		
H7330	002	0	1	02	01	H7330_002_0	8	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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 Brand, Specialty Tier												
H7330	002	0	1	02	01	H7330_002_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7330	002	0	1	02	01	H7330_002_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7330	002	0	1	02	01	H7330_002_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7330	003	0	1	01	01	H7330_003_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7330	003	0	1	01	01	H7330_003_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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		
H7330	003	0	1	01	01	H7330_003_0	8	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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 Brand, Specialty Tier												
H7330	003	0	1	01	01	H7330_003_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7330	003	0	1	01	01	H7330_003_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7330	003	0	1	01	01	H7330_003_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7330	004	0	1	02	01	H7330_004_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7330	004	0	1	02	01	H7330_004_0	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7330	004	0	1	02	01	H7330_004_0	9	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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 Brand, Specialty Tier												
H7330	004	0	1	02	01	H7330_004_0	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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 Brand, Specialty Tier												
H7330	004	0	1	02	01	H7330_004_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	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 Brand, Specialty Tier												
H7330	004	0	1	02	01	H7330_004_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7360	001	0	1	04	01	H7360_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7360	001	0	1	04	01	H7360_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H7360	001	0	1	04	01	H7360_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7360	001	0	1	04	01	H7360_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.32	45	45	45				94.90	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7360	001	0	1	04	01	H7360_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7360	001	0	1	04	01	H7360_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7389	001	0	1	01	01	H7389_001_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	001	0	1	01	01	H7389_001_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	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												
H7389	001	0	1	01	01	H7389_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	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												
H7389	001	0	1	01	01	H7389_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H7389	001	0	1	01	01	H7389_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											899.19	33						916.25	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	002	0	1	01	01	H7389_002_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	002	0	1	01	01	H7389_002_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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		
H7389	002	0	1	01	01	H7389_002_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	002	0	1	01	01	H7389_002_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7389	002	0	1	01	01	H7389_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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												
H7389	002	0	1	01	01	H7389_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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												
H7389	002	0	1	01	01	H7389_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											899.19	33						916.25	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	003	0	1	01	01	H7389_003_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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												
H7389	003	0	1	01	01	H7389_003_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		
H7389	003	0	1	01	01	H7389_003_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	24.00					4.00	8.00	8.00											12.00	24.00	24.00				4.00	8.00	0.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	003	0	1	01	01	H7389_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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												
H7389	003	0	1	01	01	H7389_003_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											92.28	50	50	50				76.53	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	003	0	1	01	01	H7389_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											742.01	33						750.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	004	0	1	01	01	H7389_004_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H7389	004	0	1	01	01	H7389_004_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	24.00					4.00	8.00	8.00											12.00	24.00	24.00				4.00	8.00	0.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	004	0	1	01	01	H7389_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	004	0	1	01	01	H7389_004_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											92.28	50	50	50				76.53	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	004	0	1	01	01	H7389_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											742.01	33						750.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	005	0	1	01	01	H7389_005_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H7389	005	0	1	01	01	H7389_005_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	24.00					4.00	8.00	8.00											12.00	24.00	24.00				4.00	8.00	0.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	005	0	1	01	01	H7389_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	005	0	1	01	01	H7389_005_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											88.59	48	48	48				73.47	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	005	0	1	01	01	H7389_005_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											742.01	33						750.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7399	001	0	1	01	01	H7399_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	001	0	1	01	01	H7399_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	0.00				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	001	0	1	01	01	H7399_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7399	001	0	1	01	01	H7399_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7399	001	0	1	01	01	H7399_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	001	0	1	01	01	H7399_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	002	0	1	01	01	H7399_002_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7399	002	0	1	01	01	H7399_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	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												
H7399	002	0	1	01	01	H7399_002_0	4	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	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										1		
H7399	002	0	1	01	01	H7399_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7399	002	0	1	01	01	H7399_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7399	002	0	1	01	01	H7399_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	002	0	1	01	01	H7399_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H7404	001	0	1	04	01	H7404_001_0	6	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	001	0	1	04	01	H7404_001_0	6	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	001	0	1	04	01	H7404_001_0	6	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												
H7404	001	0	1	04	01	H7404_001_0	6	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
H7404	001	0	1	04	01	H7404_001_0	6	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	001	0	1	04	01	H7404_001_0	6	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	001	0	1	04	01	H7404_001_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				308.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	3	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	002	0	1	04	01	H7404_002_0	3	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	002	0	1	04	01	H7404_002_0	3	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												
H7404	002	0	1	04	01	H7404_002_0	3	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
H7404	002	0	1	04	01	H7404_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				386.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	3	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		
H7404	005	0	1	04	01	H7404_005_0	3	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												
H7404	005	0	1	04	01	H7404_005_0	3	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
H7404	005	0	1	04	01	H7404_005_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				276.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	006	0	1	04	01	H7404_006_0	3	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												
H7404	006	0	1	04	01	H7404_006_0	3	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
H7404	006	0	1	04	01	H7404_006_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				173.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	011	0	1	04	01	H7404_011_0	3	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												
H7404	011	0	1	04	01	H7404_011_0	3	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
H7404	011	0	1	04	01	H7404_011_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				286.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	012	0	1	04	01	H7404_012_0	3	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	012	0	1	04	01	H7404_012_0	3	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	012	0	1	04	01	H7404_012_0	3	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												
H7404	012	0	1	04	01	H7404_012_0	3	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
H7404	012	0	1	04	01	H7404_012_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	012	0	1	04	01	H7404_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	012	0	1	04	01	H7404_012_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				287.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	014	0	1	04	01	H7404_014_0	3	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	014	0	1	04	01	H7404_014_0	3	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	014	0	1	04	01	H7404_014_0	3	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	014	0	1	04	01	H7404_014_0	3	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	014	0	1	04	01	H7404_014_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	014	0	1	04	01	H7404_014_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	014	0	1	04	01	H7404_014_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				443.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	018	0	1	04	01	H7404_018_0	3	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	3	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	3	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	3	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	018	0	1	04	01	H7404_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	018	0	1	04	01	H7404_018_0	3	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												
H7404	020	0	1	04	01	H7404_020_0	3	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	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		
H7404	020	0	1	04	01	H7404_020_0	3	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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											250.00	29						314.00	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	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	021	0	1	04	01	H7404_021_0	3	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	021	0	1	04	01	H7404_021_0	3	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	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	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	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	021	0	1	04	01	H7404_021_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				254.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	022	0	1	04	01	H7404_022_0	3	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	022	0	1	04	01	H7404_022_0	3	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	022	0	1	04	01	H7404_022_0	3	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												
H7404	022	0	1	04	01	H7404_022_0	3	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
H7404	022	0	1	04	01	H7404_022_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	022	0	1	04	01	H7404_022_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	022	0	1	04	01	H7404_022_0	3	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												
H7404	023	0	1	04	01	H7404_023_0	3	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	023	0	1	04	01	H7404_023_0	3	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	023	0	1	04	01	H7404_023_0	3	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												
H7404	023	0	1	04	01	H7404_023_0	3	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
H7404	023	0	1	04	01	H7404_023_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	023	0	1	04	01	H7404_023_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	023	0	1	04	01	H7404_023_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				420.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	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		
H7445	005	0	1	01	01	H7445_005_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				369.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	10	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 Drug, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	10	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	10.00	20.00	30.00																																						10.00			10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	10	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 Drug, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	10	Non-Preferred Drug	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 Drug, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	10	Specialty Tier	4	11	1	1	5	1	111		10			1	30	60	90				2	2								10	31					33	33	33																																				33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7512	001	0	1	04	01	H7512_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7512	001	0	1	04	01	H7512_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H7512	001	0	1	04	01	H7512_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7512	001	0	1	04	01	H7512_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7512	001	0	1	04	01	H7512_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7512	001	0	1	04	01	H7512_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7512	002	0	1	04	01	H7512_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7512	002	0	1	04	01	H7512_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H7512	002	0	1	04	01	H7512_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7512	002	0	1	04	01	H7512_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7512	002	0	1	04	01	H7512_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7512	002	0	1	04	01	H7512_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7512	003	0	1	04	01	H7512_003_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7512	003	0	1	04	01	H7512_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H7512	003	0	1	04	01	H7512_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7512	003	0	1	04	01	H7512_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7512	003	0	1	04	01	H7512_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7512	003	0	1	04	01	H7512_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7512	004	0	1	04	01	H7512_004_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7512	004	0	1	04	01	H7512_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H7512	004	0	1	04	01	H7512_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7512	004	0	1	04	01	H7512_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7512	004	0	1	04	01	H7512_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7512	004	0	1	04	01	H7512_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	001	0	1	04	01	H7518_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	001	0	1	04	01	H7518_001_0	4	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					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												
H7518	001	0	1	04	01	H7518_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7518	001	0	1	04	01	H7518_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.62	44	44	44				95.09	42	42	42										44	44	44				42	42	42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	001	0	1	04	01	H7518_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	001	0	1	04	01	H7518_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	003	0	1	04	01	H7518_003_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	003	0	1	04	01	H7518_003_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	7.00	14.00	21.00																									7.00	14.00	21.00				7.00	14.00	0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	003	0	1	04	01	H7518_003_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	003	0	1	04	01	H7518_003_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.79	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	003	0	1	04	01	H7518_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	003	0	1	04	01	H7518_003_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	004	0	1	04	01	H7518_004_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	004	0	1	04	01	H7518_004_0	4	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					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												
H7518	004	0	1	04	01	H7518_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7518	004	0	1	04	01	H7518_004_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.55	45	45	45				95.12	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	004	0	1	04	01	H7518_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	004	0	1	04	01	H7518_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	005	0	1	04	01	H7518_005_0	4	Preferred Generic	4	11	3	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, Select Care Drugs												
H7518	005	0	1	04	01	H7518_005_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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												
H7518	005	0	1	04	01	H7518_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H7518	005	0	1	04	01	H7518_005_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											96.97	45	45	45				92.66	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	005	0	1	04	01	H7518_005_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7518	005	0	1	04	01	H7518_005_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7556	001	0	1	04	01	H7556_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7556	001	0	1	04	01	H7556_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H7556	001	0	1	04	01	H7556_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7556	001	0	1	04	01	H7556_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7556	001	0	1	04	01	H7556_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7556	001	0	1	04	01	H7556_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7556	002	0	1	04	01	H7556_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7556	002	0	1	04	01	H7556_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H7556	002	0	1	04	01	H7556_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7556	002	0	1	04	01	H7556_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7556	002	0	1	04	01	H7556_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7556	002	0	1	04	01	H7556_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7556	003	0	1	04	01	H7556_003_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7556	003	0	1	04	01	H7556_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H7556	003	0	1	04	01	H7556_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7556	003	0	1	04	01	H7556_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7556	003	0	1	04	01	H7556_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7556	003	0	1	04	01	H7556_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7556	004	0	1	04	01	H7556_004_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7556	004	0	1	04	01	H7556_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H7556	004	0	1	04	01	H7556_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7556	004	0	1	04	01	H7556_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7556	004	0	1	04	01	H7556_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7556	004	0	1	04	01	H7556_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	7	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	7	Preferred Generic	4	01	1	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, Select Care Drugs										1		
H7594	001	0	1	01	01	H7594_001_0	7	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		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	001	0	1	01	01	H7594_001_0	7	Generic	4	01	1	2	2	3	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		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7594	001	0	1	01	01	H7594_001_0	7	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	001	0	1	01	01	H7594_001_0	7	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	7	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	7	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	001	0	1	01	01	H7594_001_0	7	Select Care Drugs	4	11	1	2	6	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, Select Care Drugs										1		
H7594	002	0	1	01	01	H7594_002_0	7	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	7	Preferred Generic	4	01	1	1	1	3	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										1		
H7594	002	0	1	01	01	H7594_002_0	7	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	7	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	7	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	7	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	7	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	002	0	1	01	01	H7594_002_0	7	Select Care Drugs	4	11	1	1	6	3	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										1		
H7594	003	0	1	01	01	H7594_003_0	7	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	7	Preferred Generic	4	01	1	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, Select Care Drugs										1		
H7594	003	0	1	01	01	H7594_003_0	7	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	1	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												
H7594	003	0	1	01	01	H7594_003_0	7	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	1	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										1		
H7594	003	0	1	01	01	H7594_003_0	7	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	7	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	7	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	7	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	003	0	1	01	01	H7594_003_0	7	Select Care Drugs	4	11	1	2	6	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, Select Care Drugs										1		
H7594	004	0	1	01	01	H7594_004_0	7	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	7	Preferred Generic	4	01	1	1	1	3	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										1		
H7594	004	0	1	01	01	H7594_004_0	7	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	7	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	7	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	7	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	7	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	004	0	1	01	01	H7594_004_0	7	Select Care Drugs	4	11	1	1	6	3	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										1		
H7598	001	0	1	01	01	H7598_001_0	3	Preferred Generic	3	01	1	2	1	1	111		01			1	30	60	90				2	2							30		31	2.00	4.00	6.00																																					2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7598	001	0	1	01	01	H7598_001_0	3	Generic	3	01	1	2	2	1	111		01			1	30	60	90				2	2							30		31	20.00	40.00	60.00																																					20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7598	001	0	1	01	01	H7598_001_0	3	Preferred Brand	3	10	1	2	3	1	111		01			1	30	60	90				2	2							30		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												
H7598	001	0	1	01	01	H7598_001_0	3	Non-Preferred Drug	3	10	1	1	4	1	111		01			1	30	60	90				2	2							30		31				46.20	44	44	44																																			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7598	001	0	1	01	01	H7598_001_0	3	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	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	1	1	01	01	H7607_002_1	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	1	1	01	01	H7607_002_1	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	1	1	01	01	H7607_002_1	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	1	1	01	01	H7607_002_1	13	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	13	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	99.00		297.00																					198.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	1	1	01	01	H7607_002_1	13	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				976.44	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	13	Supplemental Drugs	4	01	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												
H7607	002	2	1	01	01	H7607_002_2	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	2	1	01	01	H7607_002_2	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	2	1	01	01	H7607_002_2	13	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	13	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	99.00		297.00																					198.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	13	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				976.44	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	13	Supplemental Drugs	4	01	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												
H7607	002	3	1	01	01	H7607_002_3	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	3	1	01	01	H7607_002_3	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	3	1	01	01	H7607_002_3	13	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	13	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	99.00		297.00																					198.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	13	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				976.44	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	13	Supplemental Drugs	4	01	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												
H7607	003	1	1	01	01	H7607_003_1	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	1	1	01	01	H7607_003_1	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	003	1	1	01	01	H7607_003_1	13	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				16.12	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	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	003	1	1	01	01	H7607_003_1	13	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				138.73	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	13	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				102.98	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	13	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				716.81	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	13	Supplemental Drugs	4	01	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												
H7607	003	2	1	01	01	H7607_003_2	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	2	1	01	01	H7607_003_2	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	003	2	1	01	01	H7607_003_2	13	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				16.12	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	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	003	2	1	01	01	H7607_003_2	13	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				138.73	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	13	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				102.98	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	13	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				716.81	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	13	Supplemental Drugs	4	01	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												
H7607	003	3	1	01	01	H7607_003_3	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	3	1	01	01	H7607_003_3	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	003	3	1	01	01	H7607_003_3	13	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				16.12	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	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	003	3	1	01	01	H7607_003_3	13	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				138.73	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	13	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				102.98	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	13	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				716.81	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	13	Supplemental Drugs	4	01	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												
H7607	007	1	1	01	01	H7607_007_1	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	1	1	01	01	H7607_007_1	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	1	1	01	01	H7607_007_1	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	1	1	01	01	H7607_007_1	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	1	1	01	01	H7607_007_1	13	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	007	1	1	01	01	H7607_007_1	13	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	99.00		297.00																					198.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	1	1	01	01	H7607_007_1	13	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				961.87	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	1	1	01	01	H7607_007_1	13	Supplemental Drugs	4	01	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												
H7607	007	2	1	01	01	H7607_007_2	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	2	1	01	01	H7607_007_2	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	2	1	01	01	H7607_007_2	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	2	1	01	01	H7607_007_2	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	2	1	01	01	H7607_007_2	13	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	007	2	1	01	01	H7607_007_2	13	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	99.00		297.00																					198.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	2	1	01	01	H7607_007_2	13	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				961.87	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	2	1	01	01	H7607_007_2	13	Supplemental Drugs	4	01	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												
H7607	007	3	1	01	01	H7607_007_3	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	3	1	01	01	H7607_007_3	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	3	1	01	01	H7607_007_3	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	3	1	01	01	H7607_007_3	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	3	1	01	01	H7607_007_3	13	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	007	3	1	01	01	H7607_007_3	13	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	99.00		297.00																					198.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	3	1	01	01	H7607_007_3	13	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				961.87	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	3	1	01	01	H7607_007_3	13	Supplemental Drugs	4	01	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												
H7607	008	1	1	01	01	H7607_008_1	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	1	1	01	01	H7607_008_1	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	1	1	01	01	H7607_008_1	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	1	1	01	01	H7607_008_1	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	1	1	01	01	H7607_008_1	13	Preferred Brand	4	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	1	1	01	01	H7607_008_1	13	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	99.00		297.00																					198.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	1	1	01	01	H7607_008_1	13	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1149.84	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	1	1	01	01	H7607_008_1	13	Supplemental Drugs	4	01	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												
H7607	008	2	1	01	01	H7607_008_2	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	2	1	01	01	H7607_008_2	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	2	1	01	01	H7607_008_2	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	2	1	01	01	H7607_008_2	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	2	1	01	01	H7607_008_2	13	Preferred Brand	4	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	2	1	01	01	H7607_008_2	13	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	99.00		297.00																					198.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	2	1	01	01	H7607_008_2	13	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1149.84	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	2	1	01	01	H7607_008_2	13	Supplemental Drugs	4	01	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												
H7607	008	3	1	01	01	H7607_008_3	13	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	3	1	01	01	H7607_008_3	13	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	3	1	01	01	H7607_008_3	13	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	3	1	01	01	H7607_008_3	13	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	3	1	01	01	H7607_008_3	13	Preferred Brand	4	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	3	1	01	01	H7607_008_3	13	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	99.00		297.00																					198.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	3	1	01	01	H7607_008_3	13	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1149.84	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	3	1	01	01	H7607_008_3	13	Supplemental Drugs	4	01	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												
H7617	001	0	1	04	01	H7617_001_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7617	001	0	1	04	01	H7617_001_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7617	001	0	1	04	01	H7617_001_0	3	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	25		25				30.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7617	001	0	1	04	01	H7617_001_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											25.00	25		25				25.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7617	001	0	1	04	01	H7617_001_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	001	0	1	01	01	H7621_001_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	001	0	1	01	01	H7621_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	5	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7621	002	0	1	01	01	H7621_002_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	5	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7621	002	0	1	01	01	H7621_002_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	001	0	1	02	01	H7646_001_0	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											602.48	33						602.48	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	002	0	1	02	01	H7646_002_0	6	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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	6	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	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											707.51	33						707.51	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	003	0	1	02	01	H7646_003_0	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											718.60	33						718.60	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	004	0	1	02	01	H7646_004_0	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											645.14	33						645.14	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	005	0	1	02	01	H7646_005_0	7	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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	7	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	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											715.89	33						715.89	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	006	0	1	02	01	H7646_006_0	9	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	9	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	9	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											704.78	33						704.78	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	007	0	1	02	01	H7646_007_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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	007	0	1	02	01	H7646_007_0	5	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	007	0	1	02	01	H7646_007_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	007	0	1	02	01	H7646_007_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	007	0	1	02	01	H7646_007_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											714.88	33						714.88	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	008	0	1	02	01	H7646_008_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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	008	0	1	02	01	H7646_008_0	5	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	008	0	1	02	01	H7646_008_0	5	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	008	0	1	02	01	H7646_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	008	0	1	02	01	H7646_008_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											714.88	33						714.88	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7670	001	0	1	01	01	H7670_001_0	12	Preferred Generic	4	11	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												
H7670	001	0	1	01	01	H7670_001_0	12	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	1	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												
H7670	001	0	1	01	01	H7670_001_0	12	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	141.00																			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												
H7670	001	0	1	01	01	H7670_001_0	12	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7670	001	0	1	01	01	H7670_001_0	12	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				1000.00	28	28	28																		28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7670	002	0	1	01	01	H7670_002_0	12	Preferred Generic	4	11	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												
H7670	002	0	1	01	01	H7670_002_0	12	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	1	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												
H7670	002	0	1	01	01	H7670_002_0	12	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	141.00																			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												
H7670	002	0	1	01	01	H7670_002_0	12	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7670	002	0	1	01	01	H7670_002_0	12	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				1000.00	29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7678	001	0	1	01	01	H7678_001_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	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	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.46	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				738.49	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	003	0	1	01	01	H7678_003_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	003	0	1	01	01	H7678_003_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7678	003	0	1	01	01	H7678_003_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	003	0	1	01	01	H7678_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.35			1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	003	0	1	01	01	H7678_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				90.66	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	003	0	1	01	01	H7678_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				355.15	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	004	0	1	01	01	H7678_004_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7678	004	0	1	01	01	H7678_004_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7678	004	0	1	01	01	H7678_004_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7678	004	0	1	01	01	H7678_004_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7678	004	0	1	01	01	H7678_004_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				973.87	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7678	004	0	1	01	01	H7678_004_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7678	005	0	1	01	01	H7678_005_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.48			0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7678	005	0	1	01	01	H7678_005_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.65			0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7678	005	0	1	01	01	H7678_005_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7678	005	0	1	01	01	H7678_005_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7678	005	0	1	01	01	H7678_005_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				796.41	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7678	005	0	1	01	01	H7678_005_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	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 Drug, Specialty Tier, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	11	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	11	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	11	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	11	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	11	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	11	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				30		31	100.00	200.00	300.00																					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	11	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	11	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	11	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	007	0	1	01	01	H7680_007_0	11	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	007	0	1	01	01	H7680_007_0	11	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												
H7680	007	0	1	01	01	H7680_007_0	11	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	100				1	2			100				30		31				106.57	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	007	0	1	01	01	H7680_007_0	11	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				30		31	99.00	198.00	297.00																					297.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	007	0	1	01	01	H7680_007_0	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	007	0	1	01	01	H7680_007_0	11	Select Care Drugs	4	01	1	2	6	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												
H7728	002	0	1	04	01	H7728_002_0	7	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					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7728	004	1	1	04	01	H7728_004_1	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	1	1	04	01	H7728_004_1	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	1	1	04	01	H7728_004_1	7	Preferred Brand	4	11	1	2	3	1		111	01	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	1	1	04	01	H7728_004_1	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	1	1	04	01	H7728_004_1	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7728	004	2	1	04	01	H7728_004_2	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	2	1	04	01	H7728_004_2	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	2	1	04	01	H7728_004_2	7	Preferred Brand	4	11	1	2	3	1		111	01	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	2	1	04	01	H7728_004_2	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	2	1	04	01	H7728_004_2	7	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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												
H7728	005	0	1	04	01	H7728_005_0	6	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					0.00	0.00	0.00																18.00				18.00			0.60	0.43	0.00			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	005	0	1	04	01	H7728_005_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	005	0	1	04	01	H7728_005_0	6	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	6	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	8	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												
H7728	006	0	1	04	01	H7728_006_0	8	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					0.00	0.00	0.00																18.00				18.00			0.60	0.43	0.00			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	006	0	1	04	01	H7728_006_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	006	0	1	04	01	H7728_006_0	8	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	8	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	009	0	1	04	01	H7728_009_0	7	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	009	0	1	04	01	H7728_009_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	009	0	1	04	01	H7728_009_0	7	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	7	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	010	0	1	04	01	H7728_010_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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												
H7728	010	0	1	04	01	H7728_010_0	7	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					0.00	0.00	0.00																18.00				18.00			0.60	0.43	0.00			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	010	0	1	04	01	H7728_010_0	7	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	010	0	1	04	01	H7728_010_0	7	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	010	0	1	04	01	H7728_010_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	010	0	1	04	01	H7728_010_0	7	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	010	0	1	04	01	H7728_010_0	7	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	011	0	1	04	01	H7728_011_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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												
H7728	011	0	1	04	01	H7728_011_0	7	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												
H7728	011	0	1	04	01	H7728_011_0	7	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												
H7728	011	0	1	04	01	H7728_011_0	7	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												
H7728	011	0	1	04	01	H7728_011_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	011	0	1	04	01	H7728_011_0	7	Select Care Drugs	4	01	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	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												
H7728	012	0	1	04	01	H7728_012_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H7728	012	0	1	04	01	H7728_012_0	6	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					0.00	0.00	0.00																18.00				18.00			0.60	0.43	0.00			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	012	0	1	04	01	H7728_012_0	6	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	012	0	1	04	01	H7728_012_0	6	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	012	0	1	04	01	H7728_012_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	012	0	1	04	01	H7728_012_0	6	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	012	0	1	04	01	H7728_012_0	6	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		
H7746	001	0	1	01	01	H7746_001_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	001	0	1	01	01	H7746_001_0	9	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7746	001	0	1	01	01	H7746_001_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	12.50	25.00	37.50																					28.13																12.50				12.50		0.42						0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	001	0	1	01	01	H7746_001_0	9	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																					105.75																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	001	0	1	01	01	H7746_001_0	9	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																					225.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	001	0	1	01	01	H7746_001_0	9	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				1400.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	001	0	1	01	01	H7746_001_0	9	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 Brand, Specialty Tier, Select Care Drugs												
H7746	002	0	1	01	01	H7746_002_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	002	0	1	01	01	H7746_002_0	9	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7746	002	0	1	01	01	H7746_002_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	12.50	25.00	37.50																					28.13																12.50				12.50		0.42						0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	002	0	1	01	01	H7746_002_0	9	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																					105.75																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	002	0	1	01	01	H7746_002_0	9	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																					225.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	002	0	1	01	01	H7746_002_0	9	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				1500.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	002	0	1	01	01	H7746_002_0	9	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 Brand, Specialty Tier, Select Care Drugs												
H7746	003	0	1	02	01	H7746_003_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	003	0	1	02	01	H7746_003_0	9	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	3.50	7.00	10.50																					7.88																3.50				3.50		0.12						0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7746	003	0	1	02	01	H7746_003_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	12.50	25.00	37.50																					28.13																12.50				12.50		0.42						0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	003	0	1	02	01	H7746_003_0	9	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																					105.75																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	003	0	1	02	01	H7746_003_0	9	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																					225.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	003	0	1	02	01	H7746_003_0	9	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				1500.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	003	0	1	02	01	H7746_003_0	9	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 Brand, Specialty Tier, Select Care Drugs												
H7787	001	0	1	04	01	H7787_001_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	6	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											769.56	29						560.11	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	3.95	0.00	3.95	0.00	3.95	0.00	3.95			
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	9.85	0.00	9.85	0.00	9.85	0.00	9.85			
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	2	Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7844	001	0	1	48	05	H7844_001_0	2	Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7844	001	0	1	48	05	H7844_001_0	2	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7849	001	0	1	04	01	H7849_001_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				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												
H7849	001	0	1	04	01	H7849_001_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					4.00	8.00	10.00											15.00	30.00	37.50				0.00	0.00	0.00				15.00				15.00			0.50	0.13		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	001	0	1	04	01	H7849_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	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	001	0	1	04	01	H7849_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											829.74	33						622.92	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	002	0	1	04	01	H7849_002_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	24.00					4.00	8.00	8.00											12.00	24.00	24.00				4.00	8.00	0.00				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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	002	0	1	04	01	H7849_002_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.86	45	45	45				82.21	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	002	0	1	04	01	H7849_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											695.11	33						609.14	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	003	0	1	04	01	H7849_003_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	003	0	1	04	01	H7849_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											857.55	33						790.21	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	006	0	1	04	01	H7849_006_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	006	0	1	04	01	H7849_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	006	0	1	04	01	H7849_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											781.03	33						672.84	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	007	0	1	04	01	H7849_007_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	007	0	1	04	01	H7849_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	007	0	1	04	01	H7849_007_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											617.53	33						623.72	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	008	0	1	04	01	H7849_008_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	008	0	1	04	01	H7849_008_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	008	0	1	04	01	H7849_008_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											831.55	33						749.54	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	009	0	1	04	01	H7849_009_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	009	0	1	04	01	H7849_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	009	0	1	04	01	H7849_009_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											721.43	33						688.29	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	010	0	1	04	01	H7849_010_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	010	0	1	04	01	H7849_010_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	010	0	1	04	01	H7849_010_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	010	0	1	04	01	H7849_010_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											857.05	33						609.90	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	011	0	1	04	01	H7849_011_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	011	0	1	04	01	H7849_011_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	011	0	1	04	01	H7849_011_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	011	0	1	04	01	H7849_011_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											842.26	33						678.80	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	012	0	1	04	01	H7849_012_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	012	0	1	04	01	H7849_012_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	012	0	1	04	01	H7849_012_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											798.37	33						765.98	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	013	0	1	04	01	H7849_013_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	013	0	1	04	01	H7849_013_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	013	0	1	04	01	H7849_013_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											772.87	33						631.45	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	014	0	1	04	01	H7849_014_0	4	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	4	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	014	0	1	04	01	H7849_014_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	014	0	1	04	01	H7849_014_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											766.40	30						596.78	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	015	0	1	04	01	H7849_015_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	015	0	1	04	01	H7849_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	015	0	1	04	01	H7849_015_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											914.60	33						760.36	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	016	0	1	04	01	H7849_016_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	016	0	1	04	01	H7849_016_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	016	0	1	04	01	H7849_016_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											729.24	30						596.33	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	017	0	1	04	01	H7849_017_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	017	0	1	04	01	H7849_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	017	0	1	04	01	H7849_017_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											876.13	33						681.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	018	0	1	04	01	H7849_018_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7849	018	0	1	04	01	H7849_018_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	018	0	1	04	01	H7849_018_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	018	0	1	04	01	H7849_018_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											804.36	33						719.59	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	019	0	1	04	01	H7849_019_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	20.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	019	0	1	04	01	H7849_019_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	019	0	1	04	01	H7849_019_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	019	0	1	04	01	H7849_019_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											935.68	33						744.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	020	0	1	04	01	H7849_020_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	020	0	1	04	01	H7849_020_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	020	0	1	04	01	H7849_020_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											748.43	29						621.63	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	021	0	1	04	01	H7849_021_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	021	0	1	04	01	H7849_021_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	021	0	1	04	01	H7849_021_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											892.11	33						732.95	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	022	0	1	04	01	H7849_022_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	022	0	1	04	01	H7849_022_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	022	0	1	04	01	H7849_022_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											748.43	29						621.63	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	023	0	1	04	01	H7849_023_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	023	0	1	04	01	H7849_023_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	023	0	1	04	01	H7849_023_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											820.03	31						672.84	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	024	0	1	04	01	H7849_024_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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												
H7849	024	0	1	04	01	H7849_024_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	024	0	1	04	01	H7849_024_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											87.10	50	50	50				69.04	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	024	0	1	04	01	H7849_024_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											914.60	33						760.36	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	026	0	1	04	01	H7849_026_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	026	0	1	04	01	H7849_026_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					4.00	8.00	10.00											15.00	30.00	37.50				0.00	0.00	0.00				15.00				15.00			0.50	0.13		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	026	0	1	04	01	H7849_026_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	026	0	1	04	01	H7849_026_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											742.88	33						625.72	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	027	0	1	04	01	H7849_027_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				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												
H7849	027	0	1	04	01	H7849_027_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					4.00	8.00	10.00											15.00	30.00	37.50				0.00	0.00	0.00				15.00				15.00			0.50	0.13		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	027	0	1	04	01	H7849_027_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	027	0	1	04	01	H7849_027_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											742.88	33						625.72	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	028	0	1	04	01	H7849_028_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	028	0	1	04	01	H7849_028_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	028	0	1	04	01	H7849_028_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											743.35	33						626.10	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	Preferred Generic	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	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	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	029	0	1	04	01	H7849_029_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	029	0	1	04	01	H7849_029_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											743.35	33						626.10	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	030	0	1	04	01	H7849_030_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	030	0	1	04	01	H7849_030_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	030	0	1	04	01	H7849_030_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											809.32	33						798.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	031	0	1	04	01	H7849_031_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	031	0	1	04	01	H7849_031_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	031	0	1	04	01	H7849_031_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											805.02	33						795.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	032	0	1	04	01	H7849_032_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	032	0	1	04	01	H7849_032_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	032	0	1	04	01	H7849_032_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											805.02	33						795.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	033	0	1	04	01	H7849_033_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	033	0	1	04	01	H7849_033_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	033	0	1	04	01	H7849_033_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											809.32	33						798.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	034	0	1	04	01	H7849_034_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	034	0	1	04	01	H7849_034_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	034	0	1	04	01	H7849_034_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	034	0	1	04	01	H7849_034_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											914.60	33						760.36	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	035	0	1	04	01	H7849_035_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	035	0	1	04	01	H7849_035_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	035	0	1	04	01	H7849_035_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	035	0	1	04	01	H7849_035_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	035	0	1	04	01	H7849_035_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											913.94	33						747.45	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	036	0	1	04	01	H7849_036_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	036	0	1	04	01	H7849_036_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	036	0	1	04	01	H7849_036_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											914.60	33						760.36	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	037	0	1	04	01	H7849_037_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	037	0	1	04	01	H7849_037_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	037	0	1	04	01	H7849_037_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											914.60	33						760.36	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	038	0	1	04	01	H7849_038_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	038	0	1	04	01	H7849_038_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	038	0	1	04	01	H7849_038_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											756.80	29						622.55	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	039	0	1	04	01	H7849_039_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	039	0	1	04	01	H7849_039_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	039	0	1	04	01	H7849_039_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											756.80	29						622.55	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	040	0	1	04	01	H7849_040_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	040	0	1	04	01	H7849_040_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	040	0	1	04	01	H7849_040_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	040	0	1	04	01	H7849_040_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											756.80	29						622.55	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	041	0	1	04	01	H7849_041_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	041	0	1	04	01	H7849_041_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	041	0	1	04	01	H7849_041_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											756.80	29						622.55	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	042	0	1	04	01	H7849_042_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	042	0	1	04	01	H7849_042_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	042	0	1	04	01	H7849_042_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											756.80	29						622.55	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	043	0	1	04	01	H7849_043_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	043	0	1	04	01	H7849_043_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	043	0	1	04	01	H7849_043_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											914.60	33						760.36	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	044	0	1	04	01	H7849_044_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	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	044	0	1	04	01	H7849_044_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	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	044	0	1	04	01	H7849_044_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	044	0	1	04	01	H7849_044_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	044	0	1	04	01	H7849_044_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											802.63	31						714.04	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	045	0	1	04	01	H7849_045_0	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											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	045	0	1	04	01	H7849_045_0	9	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	20.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	045	0	1	04	01	H7849_045_0	9	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	045	0	1	04	01	H7849_045_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	045	0	1	04	01	H7849_045_0	9	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											804.36	33						719.59	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	046	0	1	04	01	H7849_046_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	046	0	1	04	01	H7849_046_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	20.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	046	0	1	04	01	H7849_046_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	046	0	1	04	01	H7849_046_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	046	0	1	04	01	H7849_046_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											935.68	33						744.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	047	0	1	04	01	H7849_047_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					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	047	0	1	04	01	H7849_047_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	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	047	0	1	04	01	H7849_047_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	047	0	1	04	01	H7849_047_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	047	0	1	04	01	H7849_047_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											876.13	33						681.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	048	0	1	04	01	H7849_048_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					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	048	0	1	04	01	H7849_048_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	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	048	0	1	04	01	H7849_048_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	048	0	1	04	01	H7849_048_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	048	0	1	04	01	H7849_048_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											876.13	33						681.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	050	0	1	04	01	H7849_050_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				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												
H7849	050	0	1	04	01	H7849_050_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					4.00	8.00	10.00											15.00	30.00	37.50				0.00	0.00	0.00				15.00				15.00			0.50	0.13		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	050	0	1	04	01	H7849_050_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	050	0	1	04	01	H7849_050_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	050	0	1	04	01	H7849_050_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											742.88	33						625.72	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	051	0	1	04	01	H7849_051_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				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												
H7849	051	0	1	04	01	H7849_051_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					4.00	8.00	10.00											15.00	30.00	37.50				0.00	0.00	0.00				15.00				15.00			0.50	0.13		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	051	0	1	04	01	H7849_051_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	051	0	1	04	01	H7849_051_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	051	0	1	04	01	H7849_051_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											742.88	33						625.72	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	052	0	1	04	01	H7849_052_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					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												
H7849	052	0	1	04	01	H7849_052_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					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		
H7849	052	0	1	04	01	H7849_052_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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												
H7849	052	0	1	04	01	H7849_052_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	052	0	1	04	01	H7849_052_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	052	0	1	04	01	H7849_052_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											878.89	33						744.79	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	054	0	1	04	01	H7849_054_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					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												
H7849	054	0	1	04	01	H7849_054_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					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		
H7849	054	0	1	04	01	H7849_054_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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												
H7849	054	0	1	04	01	H7849_054_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	054	0	1	04	01	H7849_054_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	054	0	1	04	01	H7849_054_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											878.89	33						744.79	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	055	0	1	04	01	H7849_055_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	055	0	1	04	01	H7849_055_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	20.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	055	0	1	04	01	H7849_055_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	055	0	1	04	01	H7849_055_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	055	0	1	04	01	H7849_055_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											622.65	29						541.10	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	056	0	1	04	01	H7849_056_0	6	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	056	0	1	04	01	H7849_056_0	6	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	056	0	1	04	01	H7849_056_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	056	0	1	04	01	H7849_056_0	6	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	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		
H7849	056	0	1	04	01	H7849_056_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	056	0	1	04	01	H7849_056_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	056	0	1	04	01	H7849_056_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											766.40	30						596.78	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	057	0	1	04	01	H7849_057_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					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	057	0	1	04	01	H7849_057_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	24.00					4.00	8.00	8.00											12.00	24.00	24.00				4.00	8.00	0.00				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	057	0	1	04	01	H7849_057_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	057	0	1	04	01	H7849_057_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											92.28	50	50	50				76.53	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	057	0	1	04	01	H7849_057_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											742.01	33						750.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	058	0	1	04	01	H7849_058_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					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	058	0	1	04	01	H7849_058_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	24.00					4.00	8.00	8.00											12.00	24.00	24.00				4.00	8.00	0.00				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	058	0	1	04	01	H7849_058_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	058	0	1	04	01	H7849_058_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											92.28	50	50	50				76.53	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	058	0	1	04	01	H7849_058_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											742.01	33						750.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	059	0	1	04	01	H7849_059_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					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	059	0	1	04	01	H7849_059_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	24.00					4.00	8.00	8.00											12.00	24.00	24.00				4.00	8.00	0.00				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	059	0	1	04	01	H7849_059_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	059	0	1	04	01	H7849_059_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											92.28	50	50	50				76.53	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	059	0	1	04	01	H7849_059_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											742.01	33						750.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	060	0	1	04	01	H7849_060_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	060	0	1	04	01	H7849_060_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				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	060	0	1	04	01	H7849_060_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	060	0	1	04	01	H7849_060_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	060	0	1	04	01	H7849_060_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											914.60	33						760.36	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	062	0	1	04	01	H7849_062_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	062	0	1	04	01	H7849_062_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	062	0	1	04	01	H7849_062_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	062	0	1	04	01	H7849_062_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	062	0	1	04	01	H7849_062_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	062	0	1	04	01	H7849_062_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											756.45	29						622.11	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	001	0	1	01	01	H7853_001_0	7	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	7	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H7853	001	0	1	01	01	H7853_001_0	7	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	8		24																					16																8				8		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	7	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		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	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		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	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				861.20	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	7	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	7	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H7853	002	0	1	01	01	H7853_002_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H7853	002	0	1	01	01	H7853_002_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	8		24																					16																8				8		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	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		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	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				686.94	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	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		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	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H7853	010	0	1	01	01	H7853_010_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	010	0	1	01	01	H7853_010_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H7853	010	0	1	01	01	H7853_010_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				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												
H7853	010	0	1	01	01	H7853_010_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	47		141																					94																47				47		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	010	0	1	01	01	H7853_010_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	100		300																					200																100				100		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	010	0	1	01	01	H7853_010_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				668.13	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	010	0	1	01	01	H7853_010_0	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	010	0	1	01	01	H7853_010_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H7853	011	0	1	01	01	H7853_011_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	011	0	1	01	01	H7853_011_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H7853	011	0	1	01	01	H7853_011_0	6	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				7.54	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	011	0	1	01	01	H7853_011_0	6	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				90.43	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	011	0	1	01	01	H7853_011_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				49.28	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	011	0	1	01	01	H7853_011_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				566.62	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	011	0	1	01	01	H7853_011_0	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	011	0	1	01	01	H7853_011_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H7853	012	0	1	01	01	H7853_012_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	012	0	1	01	01	H7853_012_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H7853	012	0	1	01	01	H7853_012_0	6	Generic	4	11	1	2	2	1	110		01	100		1	30		100				1	2			100				30		31	5		15																					10																5				5		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	012	0	1	01	01	H7853_012_0	6	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	40		120																					80																40				40		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	012	0	1	01	01	H7853_012_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	90		270																					180																90				90		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	012	0	1	01	01	H7853_012_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				427.09	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	012	0	1	01	01	H7853_012_0	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	012	0	1	01	01	H7853_012_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H7853	013	0	1	01	01	H7853_013_0	7	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	013	0	1	01	01	H7853_013_0	7	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H7853	013	0	1	01	01	H7853_013_0	7	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				9.89	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	013	0	1	01	01	H7853_013_0	7	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				105.64	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	013	0	1	01	01	H7853_013_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				66.31	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	013	0	1	01	01	H7853_013_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				658.64	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	013	0	1	01	01	H7853_013_0	7	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	013	0	1	01	01	H7853_013_0	7	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H7853	015	0	1	01	01	H7853_015_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	015	0	1	01	01	H7853_015_0	6	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		
H7853	015	0	1	01	01	H7853_015_0	6	Generic	4	11	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				9.89	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	015	0	1	01	01	H7853_015_0	6	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				105.64	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	015	0	1	01	01	H7853_015_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				66.31	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	015	0	1	01	01	H7853_015_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				658.65	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	015	0	1	01	01	H7853_015_0	6	Select Care Drugs	4	11	3	2	6	1	110		01	100		1	30		100				1	2			100				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	015	0	1	01	01	H7853_015_0	6	Select Care Drugs	4	11	3	2	6	3	110		01	100		1	30		100				1	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, Select Care Drugs										1		3
H7885	001	0	1	48	05	H7885_001_0	3	Generic Drugs	4	01			1	1	110		01			1	30		90				2	2							30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.95	0.00	3.95			0.00	3.95			
H7885	001	0	1	48	05	H7885_001_0	3	Brand Drugs	4	10			2	1	110		01			1	30		90				2	2							30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	9.85	0.00	9.85			0.00	9.85			
H7885	001	0	1	48	05	H7885_001_0	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01			1	30		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			
H7890	001	0	1	48	05	H7890_001_0	5	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	5	Brand Drugs	4	10			2	1	111		01	100		1	31	60	90				2	2			90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	9.85	0.00	9.85			0.00	9.85			
H7890	001	0	1	48	05	H7890_001_0	5	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	5	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	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	009	0	1	04	01	H7917_009_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	95.00					28.00	56.00	70.00											33.00	66.00	95.00				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55.00	110.00	145.00					50.00	100.00	125.00											55.00	110.00	145.00				50.00	100.00	125.00					55.00			55.00			1.83	1.67		1.83	1.67	1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	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	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	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	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55.00	110.00	145.00					50.00	100.00	125.00											55.00	110.00	145.00				50.00	100.00	125.00					55.00			55.00			1.83	1.67		1.83	1.67	1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	011	0	1	04	01	H7917_011_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	95.00					28.00	56.00	70.00											33.00	66.00	95.00				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55.00	110.00	145.00					50.00	100.00	125.00											55.00	110.00	145.00				50.00	100.00	125.00					55.00			55.00			1.83	1.67		1.83	1.67	1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	012	0	1	04	01	H7917_012_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	95.00					28.00	56.00	70.00											33.00	66.00	95.00				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70.00	140.00	185.00					65.00	130.00	165.00											70.00	140.00	185.00				65.00	130.00	165.00					70.00			70.00			2.33	2.17		2.33	2.17	2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	013	0	1	04	01	H7917_013_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	95.00					28.00	56.00	70.00											33.00	66.00	95.00				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70.00	140.00	185.00					65.00	130.00	165.00											70.00	140.00	185.00				65.00	130.00	165.00					70.00			70.00			2.33	2.17		2.33	2.17	2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	014	0	1	04	01	H7917_014_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	95.00					28.00	56.00	70.00											33.00	66.00	95.00				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70.00	140.00	185.00					65.00	130.00	165.00											70.00	140.00	185.00				65.00	130.00	165.00					70.00			70.00			2.33	2.17		2.33	2.17	2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	015	0	1	04	01	H7917_015_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	95.00					28.00	56.00	70.00											33.00	66.00	95.00				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70.00	140.00	185.00					65.00	130.00	165.00											70.00	140.00	185.00				65.00	130.00	165.00					70.00			70.00			2.33	2.17		2.33	2.17	2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	030	0	1	04	01	H7917_030_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	30.00	35.00					10.00	10.00	10.00											15.00	30.00	35.00				10.00	10.00	10.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	135.00					42.00	84.00	105.00											47.00	94.00	135.00				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	194.00	285.00					92.00	184.00	225.00											97.00	194.00	285.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	031	0	1	04	01	H7917_031_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	30.00	35.00					10.00	10.00	10.00											15.00	30.00	35.00				10.00	10.00	10.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	135.00					42.00	84.00	105.00											47.00	94.00	135.00				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	194.00	285.00					92.00	184.00	225.00											97.00	194.00	285.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	032	0	1	04	01	H7917_032_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	30.00	35.00					10.00	10.00	10.00											15.00	30.00	35.00				10.00	10.00	10.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	135.00					42.00	84.00	105.00											47.00	94.00	135.00				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	194.00	285.00					92.00	184.00	225.00											97.00	194.00	285.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	033	0	1	04	01	H7917_033_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	30.00	35.00					10.00	10.00	10.00											15.00	30.00	35.00				10.00	10.00	10.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	135.00					42.00	84.00	105.00											47.00	94.00	135.00				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	194.00	285.00					92.00	184.00	225.00											97.00	194.00	285.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	034	0	1	04	01	H7917_034_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	034	0	1	04	01	H7917_034_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	034	0	1	04	01	H7917_034_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	034	0	1	04	01	H7917_034_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	035	0	1	04	01	H7917_035_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	035	0	1	04	01	H7917_035_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	035	0	1	04	01	H7917_035_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	035	0	1	04	01	H7917_035_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	036	0	1	04	01	H7917_036_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	036	0	1	04	01	H7917_036_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	036	0	1	04	01	H7917_036_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	036	0	1	04	01	H7917_036_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	037	0	1	04	01	H7917_037_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	037	0	1	04	01	H7917_037_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	037	0	1	04	01	H7917_037_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	037	0	1	04	01	H7917_037_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	038	0	1	04	01	H7917_038_0	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	038	0	1	04	01	H7917_038_0	8	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	038	0	1	04	01	H7917_038_0	8	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	30.00	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	038	0	1	04	01	H7917_038_0	8	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	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	038	0	1	04	01	H7917_038_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								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	038	0	1	04	01	H7917_038_0	8	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7925	001	0	1	01	01	H7925_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	001	0	1	01	01	H7925_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	0.00				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	001	0	1	01	01	H7925_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7925	001	0	1	01	01	H7925_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7925	001	0	1	01	01	H7925_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	001	0	1	01	01	H7925_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	002	0	1	01	01	H7925_002_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7925	002	0	1	01	01	H7925_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	002	0	1	01	01	H7925_002_0	4	Generic	4	11	1	2	2	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											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7925	002	0	1	01	01	H7925_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H7925	002	0	1	01	01	H7925_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H7925	002	0	1	01	01	H7925_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	002	0	1	01	01	H7925_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H7925	003	0	1	01	01	H7925_003_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	003	0	1	01	01	H7925_003_0	4	Generic	4	11	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	12.00	0.00				6.00				6.00		0.2				0.2	0.2	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	003	0	1	01	01	H7925_003_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	43.00	86.00	129.00																									43.00	86.00	129.00				43.00	86.00	86.00				43.00				43.00		1.43				1.43	1.43	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	003	0	1	01	01	H7925_003_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.15	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	003	0	1	01	01	H7925_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	003	0	1	01	01	H7925_003_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7971	003	0	1	04	01	H7971_003_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7971	003	0	1	04	01	H7971_003_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			5.00	10.00	15.00																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	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7971	003	0	1	04	01	H7971_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				51.78	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	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				551.17	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	001	0	1	01	01	H7993_001_0	8	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	8	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	8	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	8	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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				982.19	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	002	0	1	01	01	H7993_002_0	9	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	9	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	9	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	9	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	9	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	002	0	1	01	01	H7993_002_0	9	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	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1161.03	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	003	0	1	01	01	H7993_003_0	8	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	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										2	2	
H7993	003	0	1	01	01	H7993_003_0	8	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	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										2	2	3
H7993	003	0	1	01	01	H7993_003_0	8	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	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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				964.92	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	004	0	1	01	01	H7993_004_0	10	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	10	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										2	2	
H7993	004	0	1	01	01	H7993_004_0	10	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	10	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										2	2	3
H7993	004	0	1	01	01	H7993_004_0	10	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				42.71	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	004	0	1	01	01	H7993_004_0	10	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				77.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	004	0	1	01	01	H7993_004_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				798.44	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	005	0	1	01	01	H7993_005_0	11	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	005	0	1	01	01	H7993_005_0	11	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										2	2	
H7993	005	0	1	01	01	H7993_005_0	11	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	005	0	1	01	01	H7993_005_0	11	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										2	2	3
H7993	005	0	1	01	01	H7993_005_0	11	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	005	0	1	01	01	H7993_005_0	11	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	005	0	1	01	01	H7993_005_0	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				747.15	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	001	0	1	04	01	H8003_001_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											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												
H8003	001	0	1	04	01	H8003_001_0	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		
H8003	001	0	1	04	01	H8003_001_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H8003	001	0	1	04	01	H8003_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								44.00	88.00	132.00					37.00	74.00	111.00											44.00	88.00	110.00				37.00	74.00	92.50				44.00				37.00			1.47	1.23		1.47	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	001	0	1	04	01	H8003_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	250.00				100.00	200.00	250.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	001	0	1	04	01	H8003_001_0	5	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												32	32	32					32	32	32										32	32	32				32	32	32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	002	0	1	04	01	H8003_002_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											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												
H8003	002	0	1	04	01	H8003_002_0	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		
H8003	002	0	1	04	01	H8003_002_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H8003	002	0	1	04	01	H8003_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								44.00	88.00	132.00					37.00	74.00	111.00											44.00	88.00	110.00				37.00	74.00	92.50				44.00				37.00			1.47	1.23		1.47	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	002	0	1	04	01	H8003_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	250.00				100.00	200.00	250.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	002	0	1	04	01	H8003_002_0	5	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												32	32	32					32	32	32										32	32	32				32	32	32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	003	0	1	04	01	H8003_003_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											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												
H8003	003	0	1	04	01	H8003_003_0	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		
H8003	003	0	1	04	01	H8003_003_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	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												
H8003	003	0	1	04	01	H8003_003_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								44.00	88.00	132.00					37.00	74.00	111.00											44.00	88.00	110.00				37.00	74.00	92.50				44.00				37.00			1.47	1.23		1.47	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	003	0	1	04	01	H8003_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	250.00				100.00	200.00	250.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	003	0	1	04	01	H8003_003_0	5	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												32	32	32					32	32	32										32	32	32				32	32	32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	004	0	1	04	01	H8003_004_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											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												
H8003	004	0	1	04	01	H8003_004_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		
H8003	004	0	1	04	01	H8003_004_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											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												
H8003	004	0	1	04	01	H8003_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	117.50				40.00	80.00	100.00				47.00				40.00			1.57	1.33		1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	004	0	1	04	01	H8003_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	250.00				100.00	200.00	250.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	004	0	1	04	01	H8003_004_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												31	31	31					31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	005	0	1	04	01	H8003_005_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H8003	005	0	1	04	01	H8003_005_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		
H8003	005	0	1	04	01	H8003_005_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	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												
H8003	005	0	1	04	01	H8003_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	117.50				40.00	80.00	100.00				47.00				40.00			1.57	1.33		1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	005	0	1	04	01	H8003_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	250.00				100.00	200.00	250.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	005	0	1	04	01	H8003_005_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												31	31	31					31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	006	0	1	04	01	H8003_006_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H8003	006	0	1	04	01	H8003_006_0	4	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		
H8003	006	0	1	04	01	H8003_006_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	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												
H8003	006	0	1	04	01	H8003_006_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	117.50				40.00	80.00	100.00				47.00				40.00			1.57	1.33		1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	006	0	1	04	01	H8003_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	250.00				100.00	200.00	250.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	006	0	1	04	01	H8003_006_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												31	31	31					31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	002	0	1	01	01	H8010_002_0	13	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	002	0	1	01	01	H8010_002_0	13	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	13	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	002	0	1	01	01	H8010_002_0	13	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	002	0	1	01	01	H8010_002_0	13	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											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	12	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	12	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	12	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	12	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	12	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	13	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	005	0	1	01	01	H8010_005_0	13	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	13	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	005	0	1	01	01	H8010_005_0	13	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	005	0	1	01	01	H8010_005_0	13	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											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	13	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	5.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	008	0	1	01	01	H8010_008_0	13	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							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	13	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							110.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	008	0	1	01	01	H8010_008_0	13	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							270.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	008	0	1	01	01	H8010_008_0	13	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											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	2	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	3.95	0.00	3.95			0.00	3.95			
H8016	001	0	1	48	05	H8016_001_0	2	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	9.85	0.00	9.85			0.00	9.85			
H8016	001	0	1	48	05	H8016_001_0	2	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	002	0	1	02	01	H8019_002_0	4	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					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, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	4	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					5.00	10.00	10.00																	12.00			12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	4	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					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, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	4	Non-Preferred Drug	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					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, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	4	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 Drug, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	4	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 Drug, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	4	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 Drug, 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	2	Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8046	001	0	1	48	05	H8046_001_0	2	Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8046	001	0	1	48	05	H8046_001_0	2	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8064	002	0	1	04	01	H8064_002_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	9	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	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	9	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	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				89.69	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				339.87	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8064	004	0	1	04	01	H8064_004_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	9	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	9	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	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	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	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				63.69	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	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				294.28	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	003	0	1	04	01	H8087_003_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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												
H8087	003	0	1	04	01	H8087_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					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												
H8087	003	0	1	04	01	H8087_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												
H8087	003	0	1	04	01	H8087_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	003	0	1	04	01	H8087_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												
H8087	004	0	1	04	01	H8087_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					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	004	0	1	04	01	H8087_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					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												
H8087	004	0	1	04	01	H8087_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												
H8087	004	0	1	04	01	H8087_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					100.00		300.00											100.00		300.00				100.00		290.00				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	004	0	1	04	01	H8087_004_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												
H8095	001	0	1	01	01	H8095_001_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					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												
H8095	001	0	1	01	01	H8095_001_0	8	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	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												
H8095	001	0	1	01	01	H8095_001_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	139.00					47.00	74.00	109.00					49.00	74.00	111.00																47.00				47.00			1.57	1.57	1.63			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8095	001	0	1	01	01	H8095_001_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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												
H8095	001	0	1	01	01	H8095_001_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1126.44	33						1126.44	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8121	001	0	1	04	01	H8121_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8121	001	0	1	04	01	H8121_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H8121	001	0	1	04	01	H8121_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H8121	001	0	1	04	01	H8121_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H8121	001	0	1	04	01	H8121_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8121	001	0	1	04	01	H8121_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8121	002	0	1	04	01	H8121_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8121	002	0	1	04	01	H8121_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H8121	002	0	1	04	01	H8121_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H8121	002	0	1	04	01	H8121_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H8121	002	0	1	04	01	H8121_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8121	002	0	1	04	01	H8121_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8130	001	0	1	01	01	H8130_001_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8130	001	0	1	01	01	H8130_001_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	5	Generic	4	11	1	2	2	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8130	001	0	1	01	01	H8130_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.87	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				637.47	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	008	0	1	01	01	H8130_008_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	008	0	1	01	01	H8130_008_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	008	0	1	01	01	H8130_008_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	008	0	1	01	01	H8130_008_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	008	0	1	01	01	H8130_008_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				756.55	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	009	0	1	01	01	H8130_009_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	009	0	1	01	01	H8130_009_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8130	009	0	1	01	01	H8130_009_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	009	0	1	01	01	H8130_009_0	5	Generic	4	11	1	2	2	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8130	009	0	1	01	01	H8130_009_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	009	0	1	01	01	H8130_009_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.58	31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	009	0	1	01	01	H8130_009_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				643.41	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	010	0	1	01	01	H8130_010_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8130	010	0	1	01	01	H8130_010_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8130	010	0	1	01	01	H8130_010_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8130	010	0	1	01	01	H8130_010_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8130	010	0	1	01	01	H8130_010_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				973.87	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8130	010	0	1	01	01	H8130_010_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8130	011	0	1	01	01	H8130_011_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.48			0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8130	011	0	1	01	01	H8130_011_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.65			0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8130	011	0	1	01	01	H8130_011_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8130	011	0	1	01	01	H8130_011_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8130	011	0	1	01	01	H8130_011_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				796.41	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8130	011	0	1	01	01	H8130_011_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	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 Drug, Specialty Tier, Select Care Drugs												
H8133	001	0	1	01	01	H8133_001_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8133	001	0	1	01	01	H8133_001_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8133	001	0	1	01	01	H8133_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8133	003	0	1	01	01	H8133_003_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8133	003	0	1	01	01	H8133_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8133	005	0	1	01	01	H8133_005_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8133	005	0	1	01	01	H8133_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	001	0	1	01	01	H8142_001_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	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	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	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	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	002	0	1	01	01	H8142_002_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	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	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	30.00																			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	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	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	6	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	6	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	6	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	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	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	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	007	0	1	01	01	H8142_007_0	6	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	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	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	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	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	6	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	3	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	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	008	0	1	09	04	H8145_008_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	4	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				28.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											21.00	25		25				21.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	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	125	0	1	09	04	H8145_125_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	3	Non-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	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												
H8166	001	0	1	04	01	H8166_001_0	6	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							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	001	0	1	04	01	H8166_001_0	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					7.00		21.00							0.00																15.00				15.00			0.48	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	001	0	1	04	01	H8166_001_0	6	Preferred Brand	4	11	1	2	3	1		110	01	100		1				31		90	1	2			90				31		31								47.00		141.00					47.00		141.00							120.00																47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	001	0	1	04	01	H8166_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		300.00							275.00																100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	001	0	1	04	01	H8166_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											777.68	33						777.68	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	002	0	1	04	01	H8166_002_0	6	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							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	002	0	1	04	01	H8166_002_0	6	Generic	4	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								15.00		45.00					5.00		15.00							0.00																15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	002	0	1	04	01	H8166_002_0	6	Preferred Brand	4	11	1	2	3	1		110	01	100		1				31		90	1	2			90				31		31								47.00		141.00					47.00		141.00							120.00																47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	002	0	1	04	01	H8166_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				31		90	1	2			90				31		31								100.00		300.00					100.00		300.00							275.00																100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	002	0	1	04	01	H8166_002_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											775.30	33						775.30	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	001	0	1	01	01	H8173_001_0	8	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	8	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										2	2	
H8173	001	0	1	01	01	H8173_001_0	8	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	8	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										2	2	3
H8173	001	0	1	01	01	H8173_001_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				958.21	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	002	0	1	01	01	H8173_002_0	11	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	11	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	11	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				110.74	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	002	0	1	01	01	H8173_002_0	11	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				149.91	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	002	0	1	01	01	H8173_002_0	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				825.37	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	003	0	1	01	01	H8173_003_0	8	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	8	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										2	2	
H8173	003	0	1	01	01	H8173_003_0	8	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	8	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										2	2	3
H8173	003	0	1	01	01	H8173_003_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	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	8	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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1058.50	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	004	0	1	01	01	H8173_004_0	10	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	004	0	1	01	01	H8173_004_0	10	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										2	2	
H8173	004	0	1	01	01	H8173_004_0	10	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	004	0	1	01	01	H8173_004_0	10	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										2	2	3
H8173	004	0	1	01	01	H8173_004_0	10	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	004	0	1	01	01	H8173_004_0	10	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	004	0	1	01	01	H8173_004_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				732.91	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	006	0	1	01	01	H8173_006_0	10	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	006	0	1	01	01	H8173_006_0	10	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										2	2	
H8173	006	0	1	01	01	H8173_006_0	10	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	006	0	1	01	01	H8173_006_0	10	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										2	2	3
H8173	006	0	1	01	01	H8173_006_0	10	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	006	0	1	01	01	H8173_006_0	10	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	006	0	1	01	01	H8173_006_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				738.06	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	007	0	1	01	01	H8173_007_0	8	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	007	0	1	01	01	H8173_007_0	8	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	007	0	1	01	01	H8173_007_0	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	007	0	1	01	01	H8173_007_0	8	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												
H8173	007	0	1	01	01	H8173_007_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				965.36	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	008	0	1	01	01	H8173_008_0	10	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	008	0	1	01	01	H8173_008_0	10	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	008	0	1	01	01	H8173_008_0	10	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				115.37	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	008	0	1	01	01	H8173_008_0	10	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				157.06	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	008	0	1	01	01	H8173_008_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				835.06	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	010	0	1	01	01	H8173_010_0	10	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	010	0	1	01	01	H8173_010_0	10	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										2	2	
H8173	010	0	1	01	01	H8173_010_0	10	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	010	0	1	01	01	H8173_010_0	10	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										2	2	3
H8173	010	0	1	01	01	H8173_010_0	10	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	010	0	1	01	01	H8173_010_0	10	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	010	0	1	01	01	H8173_010_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				727.84	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	001	0	1	01	01	H8176_001_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	001	0	1	01	01	H8176_001_0	5	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	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	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	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.35	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	001	0	1	01	01	H8176_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				684.74	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	003	0	1	01	01	H8176_003_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8176	003	0	1	01	01	H8176_003_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8176	003	0	1	01	01	H8176_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8176	003	0	1	01	01	H8176_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8176	003	0	1	01	01	H8176_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				973.87	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8176	003	0	1	01	01	H8176_003_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8181	001	0	1	04	01	H8181_001_0	5	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																			2.00	4.00	0.00																0.00				0.00		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	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	0.00																8.00				8.00		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	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	37.00	74.00	111.00																			37.00	74.00	111.00																37.00				37.00		1.23			1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8181	001	0	1	04	01	H8181_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1049.38	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8189	001	0	1	01	01	H8189_001_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8189	001	0	1	01	01	H8189_001_0	6	Preferred Generic	4	11	3	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8189	001	0	1	01	01	H8189_001_0	6	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8189	001	0	1	01	01	H8189_001_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H8189	001	0	1	01	01	H8189_001_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				96.39	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8189	001	0	1	01	01	H8189_001_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8189	001	0	1	01	01	H8189_001_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8189	001	0	1	01	01	H8189_001_0	6	Select Care Drugs	4	11	1	2	6	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H8197	002	1	1	48	05	H8197_002_1	2	Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	002	1	1	48	05	H8197_002_1	2	Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	002	1	1	48	05	H8197_002_1	2	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	002	2	1	48	05	H8197_002_2	2	Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	002	2	1	48	05	H8197_002_2	2	Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	002	2	1	48	05	H8197_002_2	2	Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8211	001	0	1	04	01	H8211_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	001	0	1	04	01	H8211_001_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8211	001	0	1	04	01	H8211_001_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	001	0	1	04	01	H8211_001_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8211	001	0	1	04	01	H8211_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	001	0	1	04	01	H8211_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	001	0	1	04	01	H8211_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				170.00	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	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		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	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		
H8211	002	0	1	04	01	H8211_002_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	002	0	1	04	01	H8211_002_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8211	002	0	1	04	01	H8211_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	002	0	1	04	01	H8211_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	002	0	1	04	01	H8211_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				304.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	4	Preferred Generic	4	01	1	2	1	3	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										1		
H8211	006	0	1	04	01	H8211_006_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8211	006	0	1	04	01	H8211_006_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				321.00	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	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												
H8211	007	0	1	04	01	H8211_007_0	3	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		
H8211	007	0	1	04	01	H8211_007_0	3	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												
H8211	007	0	1	04	01	H8211_007_0	3	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
H8211	007	0	1	04	01	H8211_007_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	007	0	1	04	01	H8211_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	007	0	1	04	01	H8211_007_0	3	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												
H8211	009	0	1	04	01	H8211_009_0	3	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												
H8211	009	0	1	04	01	H8211_009_0	3	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		
H8211	009	0	1	04	01	H8211_009_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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												
H8211	009	0	1	04	01	H8211_009_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H8211	009	0	1	04	01	H8211_009_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	009	0	1	04	01	H8211_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	009	0	1	04	01	H8211_009_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				362.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8213	001	0	1	48	05	H8213_001_0	3	Generic Drugs	4	01			1	1	111		01	100		1	30	60	90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8213	001	0	1	48	05	H8213_001_0	3	Brand Drugs	4	11			2	1	111		01	100		1	30	60	90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8213	001	0	1	48	05	H8213_001_0	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	100		1	30	60	90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8225	001	0	1	01	01	H8225_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	001	0	1	01	01	H8225_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	0.00				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	001	0	1	01	01	H8225_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H8225	001	0	1	01	01	H8225_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H8225	001	0	1	01	01	H8225_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	001	0	1	01	01	H8225_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	002	0	1	01	01	H8225_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	0.00				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	002	0	1	01	01	H8225_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H8225	002	0	1	01	01	H8225_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H8225	002	0	1	01	01	H8225_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	002	0	1	01	01	H8225_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	003	0	1	01	01	H8225_003_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8225	003	0	1	01	01	H8225_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	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												
H8225	003	0	1	01	01	H8225_003_0	4	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	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										1		
H8225	003	0	1	01	01	H8225_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H8225	003	0	1	01	01	H8225_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H8225	003	0	1	01	01	H8225_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	003	0	1	01	01	H8225_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H8225	004	0	1	01	01	H8225_004_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	004	0	1	01	01	H8225_004_0	4	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8225	004	0	1	01	01	H8225_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	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												
H8225	004	0	1	01	01	H8225_004_0	4	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	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										1		
H8225	004	0	1	01	01	H8225_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H8225	004	0	1	01	01	H8225_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H8225	004	0	1	01	01	H8225_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	004	0	1	01	01	H8225_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H8225	005	0	1	01	01	H8225_005_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	005	0	1	01	01	H8225_005_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	005	0	1	01	01	H8225_005_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H8225	005	0	1	01	01	H8225_005_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.77	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	005	0	1	01	01	H8225_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	005	0	1	01	01	H8225_005_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	006	0	1	01	01	H8225_006_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	006	0	1	01	01	H8225_006_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	006	0	1	01	01	H8225_006_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H8225	006	0	1	01	01	H8225_006_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.77	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	006	0	1	01	01	H8225_006_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	006	0	1	01	01	H8225_006_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	007	0	1	02	01	H8225_007_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	007	0	1	02	01	H8225_007_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H8225	007	0	1	02	01	H8225_007_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H8225	007	0	1	02	01	H8225_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H8225	007	0	1	02	01	H8225_007_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	007	0	1	02	01	H8225_007_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	008	0	1	02	01	H8225_008_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	008	0	1	02	01	H8225_008_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H8225	008	0	1	02	01	H8225_008_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H8225	008	0	1	02	01	H8225_008_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H8225	008	0	1	02	01	H8225_008_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	008	0	1	02	01	H8225_008_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	4	Generic Drugs	4	01			1	1	111		01	111		1	30	60	100				2	2	30	60	100				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	4	Brand Drugs	4	10			2	1	111		10	111		1	30	60	100				2	2	30	60	100					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	9.85			0.00	9.85	0.00	9.85			
H8258	001	0	1	48	05	H8258_001_0	4	Non-Medicare Rx Drugs	4	11			3	1	111		01	111		1	30	60	100				1	2	30	60	100				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	4	Non-Medicare OTC Drugs	4	11			4	1	111		01	111		1	30	60	100				1	2	30	60	100				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			
H8293	001	0	1	01	01	H8293_001_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00	18.00	27.00				2.00	4.00	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	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		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												
H8293	001	0	1	01	01	H8293_001_0	5	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	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	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											854.08	33	33	33				854.08	33	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	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	001	0	1	01	01	H8332_001_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	001	0	1	01	01	H8332_001_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	001	0	1	01	01	H8332_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	001	0	1	01	01	H8332_001_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											894.29	30						394.95	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	002	0	1	01	01	H8332_002_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	002	0	1	01	01	H8332_002_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	002	0	1	01	01	H8332_002_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	002	0	1	01	01	H8332_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	002	0	1	01	01	H8332_002_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											895.86	30						393.08	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	003	0	1	01	01	H8332_003_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	003	0	1	01	01	H8332_003_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8332	003	0	1	01	01	H8332_003_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	003	0	1	01	01	H8332_003_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8332	003	0	1	01	01	H8332_003_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	003	0	1	01	01	H8332_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	003	0	1	01	01	H8332_003_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											898.80	30						389.59	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	004	0	1	01	01	H8332_004_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	004	0	1	01	01	H8332_004_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8332	004	0	1	01	01	H8332_004_0	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	004	0	1	01	01	H8332_004_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8332	004	0	1	01	01	H8332_004_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	004	0	1	01	01	H8332_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	004	0	1	01	01	H8332_004_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											958.24	33						429.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8343	001	0	1	04	01	H8343_001_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H8343	001	0	1	04	01	H8343_001_0	8	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	001	0	1	04	01	H8343_001_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	001	0	1	04	01	H8343_001_0	8	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	8	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	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H8343	002	0	1	04	01	H8343_002_0	8	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	002	0	1	04	01	H8343_002_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	002	0	1	04	01	H8343_002_0	8	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	8	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	8	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	003	0	1	04	01	H8343_003_0	8	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	003	0	1	04	01	H8343_003_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	003	0	1	04	01	H8343_003_0	8	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	8	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	007	0	1	04	01	H8343_007_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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												
H8343	007	0	1	04	01	H8343_007_0	6	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					0.00	0.00	0.00																18.00				18.00			0.60	0.43	0.00			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	007	0	1	04	01	H8343_007_0	6	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												
H8343	007	0	1	04	01	H8343_007_0	6	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												
H8343	007	0	1	04	01	H8343_007_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	007	0	1	04	01	H8343_007_0	6	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	007	0	1	04	01	H8343_007_0	6	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		
H8379	001	0	1	01	01	H8379_001_0	11	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												
H8379	001	0	1	01	01	H8379_001_0	11	Generic	3	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	39.00																13.00				13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8379	001	0	1	01	01	H8379_001_0	11	Preferred Brand	3	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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												
H8379	001	0	1	01	01	H8379_001_0	11	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				97.10	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8379	001	0	1	01	01	H8379_001_0	11	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				25.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	001	0	1	04	01	H8385_001_0	12	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	001	0	1	04	01	H8385_001_0	12	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	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	001	0	1	04	01	H8385_001_0	12	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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												
H8385	001	0	1	04	01	H8385_001_0	12	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	001	0	1	04	01	H8385_001_0	12	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	002	0	1	04	01	H8385_002_0	12	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	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	002	0	1	04	01	H8385_002_0	12	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	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	002	0	1	04	01	H8385_002_0	12	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	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												
H8385	002	0	1	04	01	H8385_002_0	12	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	002	0	1	04	01	H8385_002_0	12	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	003	0	1	04	01	H8385_003_0	12	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	7.50																			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												
H8385	003	0	1	04	01	H8385_003_0	12	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	8.00	16.00	20.00																			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												
H8385	003	0	1	04	01	H8385_003_0	12	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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												
H8385	003	0	1	04	01	H8385_003_0	12	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	003	0	1	04	01	H8385_003_0	12	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	004	0	1	04	01	H8385_004_0	12	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	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	004	0	1	04	01	H8385_004_0	12	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	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	004	0	1	04	01	H8385_004_0	12	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	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												
H8385	004	0	1	04	01	H8385_004_0	12	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	004	0	1	04	01	H8385_004_0	12	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8390	015	0	1	01	01	H8390_015_0	5	Preferred Generic	4	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												
H8390	015	0	1	01	01	H8390_015_0	5	Generic	4	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												
H8390	015	0	1	01	01	H8390_015_0	5	Preferred Brand	4	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												
H8390	015	0	1	01	01	H8390_015_0	5	Non-Preferred Drug	4	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												
H8390	015	0	1	01	01	H8390_015_0	5	Specialty Tier	4	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												
H8390	015	0	1	01	01	H8390_015_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	016	0	1	01	01	H8390_016_0	5	Preferred Generic	4	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												
H8390	016	0	1	01	01	H8390_016_0	5	Generic	4	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												
H8390	016	0	1	01	01	H8390_016_0	5	Preferred Brand	4	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												
H8390	016	0	1	01	01	H8390_016_0	5	Non-Preferred Drug	4	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												
H8390	016	0	1	01	01	H8390_016_0	5	Specialty Tier	4	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												
H8390	016	0	1	01	01	H8390_016_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8423	001	0	1	48	05	H8423_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	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	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	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	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	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	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	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	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	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	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	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	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	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	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	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	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	008	6	1	01	01	H8432_008_6	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	6	1	01	01	H8432_008_6	7	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	7	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	7	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	7	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	008	7	1	01	01	H8432_008_7	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	7	1	01	01	H8432_008_7	6	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	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	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	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	009	0	1	01	01	H8432_009_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	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	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	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	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	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	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	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	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	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	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	011	0	1	01	01	H8432_011_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	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	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	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	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	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	015	0	1	02	01	H8432_015_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	015	0	1	02	01	H8432_015_0	8	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	8	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	8	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	8	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	016	0	1	01	01	H8432_016_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	016	0	1	01	01	H8432_016_0	6	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	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	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	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	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	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	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	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	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	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	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												
H8432	027	0	1	01	01	H8432_027_0	6	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	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	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	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	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	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	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	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	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	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	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	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	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	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	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												
H8432	032	0	1	01	01	H8432_032_0	6	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	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	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	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	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	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	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												
H8432	033	0	1	01	01	H8432_033_0	6	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	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	034	0	1	01	01	H8432_034_0	6	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	034	0	1	01	01	H8432_034_0	6	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	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	034	0	1	01	01	H8432_034_0	6	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	6	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	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	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	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	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	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	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	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	038	1	1	01	01	H8432_038_1	7	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	7	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	7	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	7	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	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	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	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	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	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	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	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	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	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	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	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	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	2	1	01	01	H8432_039_2	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	039	2	1	01	01	H8432_039_2	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	2	1	01	01	H8432_039_2	7	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	7	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	2	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	2	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	2	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			
H8458	001	0	1	04	01	H8458_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8458	001	0	1	04	01	H8458_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H8458	001	0	1	04	01	H8458_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H8458	001	0	1	04	01	H8458_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.83	45	45	45				94.44	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8458	001	0	1	04	01	H8458_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8458	001	0	1	04	01	H8458_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8458	003	0	1	04	01	H8458_003_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8458	003	0	1	04	01	H8458_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H8458	003	0	1	04	01	H8458_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H8458	003	0	1	04	01	H8458_003_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.83	45	45	45				94.44	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8458	003	0	1	04	01	H8458_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8458	003	0	1	04	01	H8458_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8547	001	0	1	01	01	H8547_001_0	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8547	001	0	1	01	01	H8547_001_0	4	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8547	001	0	1	01	01	H8547_001_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8547	001	0	1	01	01	H8547_001_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8547	001	0	1	01	01	H8547_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8547	001	0	1	01	01	H8547_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8552	020	0	1	04	01	H8552_020_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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												
H8552	020	0	1	04	01	H8552_020_0	6	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					0.00	0.00	0.00																13.00				13.00			0.43	0.27	0.00			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	6	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	10	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					0.00	0.00	0.00																6.00				6.00			0.20	0.03	0.00			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	028	0	1	04	01	H8552_028_0	10	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					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												
H8552	028	0	1	04	01	H8552_028_0	10	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	10	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	10	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	10	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	10	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	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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												
H8552	029	0	1	04	01	H8552_029_0	6	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	029	0	1	04	01	H8552_029_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	029	0	1	04	01	H8552_029_0	6	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	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	9	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8552	030	0	1	04	01	H8552_030_0	9	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					0.00	0.00	0.00																4.00				4.00			0.13	0.13	0.00			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	9	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	9	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	4	Preferred Generic	4	11	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, Select Care Drugs												
H8553	001	0	1	04	01	H8553_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H8553	001	0	1	04	01	H8553_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H8553	001	0	1	04	01	H8553_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H8553	001	0	1	04	01	H8553_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8553	001	0	1	04	01	H8553_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8553	001	0	1	04	01	H8553_001_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H8553	003	0	1	04	01	H8553_003_0	4	Preferred Generic	4	11	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, Select Care Drugs												
H8553	003	0	1	04	01	H8553_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H8553	003	0	1	04	01	H8553_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H8553	003	0	1	04	01	H8553_003_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.40	45	45	45				94.98	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8553	003	0	1	04	01	H8553_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8553	003	0	1	04	01	H8553_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8553	003	0	1	04	01	H8553_003_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H8554	001	0	1	01	01	H8554_001_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8554	001	0	1	01	01	H8554_001_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8554	001	0	1	01	01	H8554_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	7	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	7	Preferred Generic	4	11	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8578	001	0	1	01	01	H8578_001_0	7	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	7	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	7	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	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1.00	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	7	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	7	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	7	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	7	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	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1.00	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	7	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	7	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	7	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	7	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	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1.00	26																																					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	7	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	7	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	7	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	7	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	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1.00	26																																					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8597	001	0	1	01	01	H8597_001_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H8597	001	0	1	01	01	H8597_001_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H8597	001	0	1	01	01	H8597_001_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8597	001	0	1	01	01	H8597_001_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											54.14	30	30	30				48.52	30	30	30										30	30	30				30	30	30				30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8597	001	0	1	01	01	H8597_001_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											616.76	25						402.73	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8597	002	0	1	01	01	H8597_002_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								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												
H8597	002	0	1	01	01	H8597_002_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H8597	002	0	1	01	01	H8597_002_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8597	002	0	1	01	01	H8597_002_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											55.30	30	30	30				49.85	30	30	30										30	30	30				30	30	30				30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8597	002	0	1	01	01	H8597_002_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											634.11	25						395.98	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8597	003	0	1	01	01	H8597_003_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H8597	003	0	1	01	01	H8597_003_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	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												
H8597	003	0	1	01	01	H8597_003_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8597	003	0	1	01	01	H8597_003_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											54.04	30	30	30				49.05	30	30	30										30	30	30				30	30	30				30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8597	003	0	1	01	01	H8597_003_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											699.31	25						455.44	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					3.00	6.00	9.00											13.00	26.00	39.00				3.00	0.00	0.00				13.00				13.00			0.43	0.10		0.43	0.10	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	0.00	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												
H8604	010	0	1	04	01	H8604_010_0	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
H8604	010	0	1	04	01	H8604_010_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	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												
H8604	010	0	1	04	01	H8604_010_0	7	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			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					3.00	6.00	9.00											13.00	26.00	39.00				3.00	0.00	0.00				13.00				13.00			0.43	0.10		0.43	0.10	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	0.00	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												
H8604	011	0	1	04	01	H8604_011_0	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
H8604	011	0	1	04	01	H8604_011_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	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												
H8604	011	0	1	04	01	H8604_011_0	7	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			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					3.00	6.00	9.00											13.00	26.00	39.00				3.00	0.00	0.00				13.00				13.00			0.43	0.10		0.43	0.10	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	7	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	0.00	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												
H8604	013	0	1	04	01	H8604_013_0	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
H8604	013	0	1	04	01	H8604_013_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	7	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			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8634	002	0	1	04	01	H8634_002_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8634	002	0	1	04	01	H8634_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_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												
H8634	003	0	1	04	01	H8634_003_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8634	003	0	1	04	01	H8634_003_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8634	003	0	1	04	01	H8634_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	4	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8634	004	0	1	04	01	H8634_004_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8634	004	0	1	04	01	H8634_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	007	0	1	04	01	H8634_007_0	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	007	0	1	04	01	H8634_007_0	4	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8634	007	0	1	04	01	H8634_007_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	007	0	1	04	01	H8634_007_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8634	007	0	1	04	01	H8634_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	007	0	1	04	01	H8634_007_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	008	0	1	04	01	H8634_008_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	008	0	1	04	01	H8634_008_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8634	008	0	1	04	01	H8634_008_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	008	0	1	04	01	H8634_008_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8634	008	0	1	04	01	H8634_008_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	008	0	1	04	01	H8634_008_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	010	0	1	04	01	H8634_010_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	010	0	1	04	01	H8634_010_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8634	010	0	1	04	01	H8634_010_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	010	0	1	04	01	H8634_010_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8634	010	0	1	04	01	H8634_010_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	010	0	1	04	01	H8634_010_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												
H8634	011	0	1	04	01	H8634_011_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	011	0	1	04	01	H8634_011_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8634	011	0	1	04	01	H8634_011_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	011	0	1	04	01	H8634_011_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8634	011	0	1	04	01	H8634_011_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	011	0	1	04	01	H8634_011_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												
H8634	012	0	1	04	01	H8634_012_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	012	0	1	04	01	H8634_012_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8634	012	0	1	04	01	H8634_012_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	012	0	1	04	01	H8634_012_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				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												
H8634	012	0	1	04	01	H8634_012_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	012	0	1	04	01	H8634_012_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	013	0	1	04	01	H8634_013_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	013	0	1	04	01	H8634_013_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8634	013	0	1	04	01	H8634_013_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	013	0	1	04	01	H8634_013_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8634	013	0	1	04	01	H8634_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	013	0	1	04	01	H8634_013_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	014	0	1	04	01	H8634_014_0	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	014	0	1	04	01	H8634_014_0	4	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		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												
H8634	014	0	1	04	01	H8634_014_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					44.00		132.00											47.00		141.00				44.00		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												
H8634	014	0	1	04	01	H8634_014_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.89	37		37				82.76	32		32										37		37				32		32			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	014	0	1	04	01	H8634_014_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												
H8634	015	0	1	04	01	H8634_015_0	6	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	015	0	1	04	01	H8634_015_0	6	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		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												
H8634	015	0	1	04	01	H8634_015_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					44.00		132.00											47.00		141.00				44.00		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												
H8634	015	0	1	04	01	H8634_015_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.19	45		45				84.83	40		40										45		45				40		40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	015	0	1	04	01	H8634_015_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	016	0	1	04	01	H8634_016_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	016	0	1	04	01	H8634_016_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H8634	016	0	1	04	01	H8634_016_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	016	0	1	04	01	H8634_016_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H8634	016	0	1	04	01	H8634_016_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	016	0	1	04	01	H8634_016_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	003	0	1	02	01	H8649_003_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	003	0	1	02	01	H8649_003_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H8649_003_0	2	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					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												
H8649	003	0	1	02	01	H8649_003_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H8649_003_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	003	0	1	02	01	H8649_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	003	0	1	02	01	H8649_003_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1175.70	33						586.31	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	008	0	1	02	01	H8649_008_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	008	0	1	02	01	H8649_008_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H8649_008_0	3	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					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												
H8649	008	0	1	02	01	H8649_008_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	02	01	H8649_008_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	008	0	1	02	01	H8649_008_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	008	0	1	02	01	H8649_008_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											849.22	29						329.21	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8677	001	0	1	48	05	H8677_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			
H8677	001	0	1	48	05	H8677_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			
H8677	001	0	1	48	05	H8677_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			
H8677	002	0	1	48	05	H8677_002_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			
H8677	002	0	1	48	05	H8677_002_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			
H8677	002	0	1	48	05	H8677_002_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			
H8711	001	0	1	04	01	H8711_001_0	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8711	001	0	1	04	01	H8711_001_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	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												
H8711	001	0	1	04	01	H8711_001_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H8711	001	0	1	04	01	H8711_001_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.33	45	45	45				94.91	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8711	001	0	1	04	01	H8711_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8711	001	0	1	04	01	H8711_001_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8711	002	0	1	04	01	H8711_002_0	6	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8711	002	0	1	04	01	H8711_002_0	6	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H8711	002	0	1	04	01	H8711_002_0	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H8711	002	0	1	04	01	H8711_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H8711	002	0	1	04	01	H8711_002_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8711	002	0	1	04	01	H8711_002_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8748	002	0	1	02	01	H8748_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	02	01	H8748_002_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8748	002	0	1	02	01	H8748_002_0	3	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												
H8748	002	0	1	02	01	H8748_002_0	3	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
H8748	002	0	1	02	01	H8748_002_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	02	01	H8748_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	02	01	H8748_002_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				381.00	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	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												
H8748	008	0	1	02	01	H8748_008_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8748	008	0	1	02	01	H8748_008_0	3	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												
H8748	008	0	1	02	01	H8748_008_0	3	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
H8748	008	0	1	02	01	H8748_008_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	02	01	H8748_008_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				446.00	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	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												
H8748	009	0	1	02	01	H8748_009_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8748	009	0	1	02	01	H8748_009_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	02	01	H8748_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				283.00	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	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												
H8748	025	0	1	02	01	H8748_025_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8748	025	0	1	02	01	H8748_025_0	3	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	025	0	1	02	01	H8748_025_0	3	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	025	0	1	02	01	H8748_025_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	025	0	1	02	01	H8748_025_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	025	0	1	02	01	H8748_025_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				531.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	7	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	7	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	7	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	7	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	7	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	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	001	0	1	01	01	H8764_001_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	001	0	1	01	01	H8764_001_0	7	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	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H8764	002	0	1	02	01	H8764_002_0	7	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	7	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	7	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	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	7	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	7	Preferred Generic	4	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	7	Generic	4	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	7	Preferred Brand	4	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	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					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	7	Specialty Tier	4	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	7	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												
H8768	003	0	1	04	01	H8768_003_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	003	0	1	04	01	H8768_003_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	003	0	1	04	01	H8768_003_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	003	0	1	04	01	H8768_003_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	003	0	1	04	01	H8768_003_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	003	0	1	04	01	H8768_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	003	0	1	04	01	H8768_003_0	3	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												
H8768	005	0	1	04	01	H8768_005_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	4	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		
H8768	005	0	1	04	01	H8768_005_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	005	0	1	04	01	H8768_005_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				470.00	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	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	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	006	0	1	04	01	H8768_006_0	3	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	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	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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				234.00	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	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	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	007	0	1	04	01	H8768_007_0	3	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	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	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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				387.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	008	0	1	04	01	H8768_008_0	5	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												
H8768	008	0	1	04	01	H8768_008_0	5	Preferred Generic	4	01	1	2	1	3	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										1		
H8768	008	0	1	04	01	H8768_008_0	5	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												
H8768	008	0	1	04	01	H8768_008_0	5	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
H8768	008	0	1	04	01	H8768_008_0	5	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												
H8768	008	0	1	04	01	H8768_008_0	5	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												
H8768	008	0	1	04	01	H8768_008_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				315.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	009	0	1	04	01	H8768_009_0	5	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												
H8768	009	0	1	04	01	H8768_009_0	5	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		
H8768	009	0	1	04	01	H8768_009_0	5	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												
H8768	009	0	1	04	01	H8768_009_0	5	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
H8768	009	0	1	04	01	H8768_009_0	5	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												
H8768	009	0	1	04	01	H8768_009_0	5	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												
H8768	009	0	1	04	01	H8768_009_0	5	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												
H8768	010	0	1	04	01	H8768_010_0	4	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	4	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		
H8768	010	0	1	04	01	H8768_010_0	4	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												
H8768	010	0	1	04	01	H8768_010_0	4	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
H8768	010	0	1	04	01	H8768_010_0	4	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					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	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											395.00	28						209.00	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	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	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		
H8768	011	0	1	04	01	H8768_011_0	3	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												
H8768	011	0	1	04	01	H8768_011_0	3	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
H8768	011	0	1	04	01	H8768_011_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											392.00	28						350.00	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	013	0	1	04	01	H8768_013_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	013	0	1	04	01	H8768_013_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	3	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												
H8768	014	0	1	04	01	H8768_014_0	3	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	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		
H8768	014	0	1	04	01	H8768_014_0	3	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												
H8768	014	0	1	04	01	H8768_014_0	3	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
H8768	014	0	1	04	01	H8768_014_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											447.00	29						206.00	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	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	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		
H8768	015	0	1	04	01	H8768_015_0	3	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												
H8768	015	0	1	04	01	H8768_015_0	3	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
H8768	015	0	1	04	01	H8768_015_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					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	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											414.00	28						352.00	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	016	0	1	04	01	H8768_016_0	5	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												
H8768	016	0	1	04	01	H8768_016_0	5	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		
H8768	016	0	1	04	01	H8768_016_0	5	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												
H8768	016	0	1	04	01	H8768_016_0	5	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
H8768	016	0	1	04	01	H8768_016_0	5	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												
H8768	016	0	1	04	01	H8768_016_0	5	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												
H8768	016	0	1	04	01	H8768_016_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				391.00	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	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												
H8768	017	1	1	04	01	H8768_017_1	3	Preferred Generic	4	01	1	2	1	3	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										1		
H8768	017	1	1	04	01	H8768_017_1	3	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												
H8768	017	1	1	04	01	H8768_017_1	3	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
H8768	017	1	1	04	01	H8768_017_1	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	1	1	04	01	H8768_017_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	1	1	04	01	H8768_017_1	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				407.00	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	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												
H8768	017	2	1	04	01	H8768_017_2	3	Preferred Generic	4	01	1	2	1	3	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										1		
H8768	017	2	1	04	01	H8768_017_2	3	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												
H8768	017	2	1	04	01	H8768_017_2	3	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
H8768	017	2	1	04	01	H8768_017_2	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	2	1	04	01	H8768_017_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	2	1	04	01	H8768_017_2	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				407.00	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	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	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		
H8768	022	0	1	04	01	H8768_022_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	022	0	1	04	01	H8768_022_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	022	0	1	04	01	H8768_022_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	022	0	1	04	01	H8768_022_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	022	0	1	04	01	H8768_022_0	3	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												
H8768	023	0	1	04	01	H8768_023_0	3	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												
H8768	023	0	1	04	01	H8768_023_0	3	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		
H8768	023	0	1	04	01	H8768_023_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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												
H8768	023	0	1	04	01	H8768_023_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	023	0	1	04	01	H8768_023_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				393.00	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	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												
H8768	024	0	1	04	01	H8768_024_0	3	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		
H8768	024	0	1	04	01	H8768_024_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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												
H8768	024	0	1	04	01	H8768_024_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	024	0	1	04	01	H8768_024_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				449.00	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	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												
H8768	026	0	1	04	01	H8768_026_0	3	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		
H8768	026	0	1	04	01	H8768_026_0	3	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												
H8768	026	0	1	04	01	H8768_026_0	3	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
H8768	026	0	1	04	01	H8768_026_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	026	0	1	04	01	H8768_026_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	026	0	1	04	01	H8768_026_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				455.00	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	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												
H8768	027	0	1	04	01	H8768_027_0	3	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		
H8768	027	0	1	04	01	H8768_027_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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												
H8768	027	0	1	04	01	H8768_027_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	027	0	1	04	01	H8768_027_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				449.00	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	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	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		
H8768	029	0	1	04	01	H8768_029_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				421.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	030	0	1	04	01	H8768_030_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	030	0	1	04	01	H8768_030_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	030	0	1	04	01	H8768_030_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				448.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	032	0	1	04	01	H8768_032_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	032	0	1	04	01	H8768_032_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
H8768	032	0	1	04	01	H8768_032_0	3	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												
H8768	032	0	1	04	01	H8768_032_0	3	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
H8768	032	0	1	04	01	H8768_032_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	032	0	1	04	01	H8768_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	032	0	1	04	01	H8768_032_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				407.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	033	0	1	04	01	H8768_033_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	033	0	1	04	01	H8768_033_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	033	0	1	04	01	H8768_033_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	033	0	1	04	01	H8768_033_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	033	0	1	04	01	H8768_033_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	033	0	1	04	01	H8768_033_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	033	0	1	04	01	H8768_033_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				368.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	8	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				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												
H8783	001	0	1	04	01	H8783_001_0	8	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	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												
H8783	001	0	1	04	01	H8783_001_0	8	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					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	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											66.00	50	50	50				66.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	8	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											1861.00	25	25	25				1861.00	25	25	25										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	9	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				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												
H8783	002	0	1	04	01	H8783_002_0	9	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								17.00	34.00	51.00					7.00	14.00	21.00											17.00	34.00	51.00				7.00	14.00	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	9	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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	9	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											82.00	50	50	50				82.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	002	0	1	04	01	H8783_002_0	9	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2405.00	28	28	28				2405.00	28	28	28										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	9	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								12.00	24.00	36.00					3.00	6.00	9.00											12.00	24.00	36.00				3.00	6.00	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	9	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	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												
H8783	003	0	1	04	01	H8783_003_0	9	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											119.00	25	25	25				81.00	17	17	17										25	25	25				17	17	17				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	003	0	1	04	01	H8783_003_0	9	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											60.00	50	50	50				60.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	003	0	1	04	01	H8783_003_0	9	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2329.00	25	25	25				2329.00	25	25	25										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	5	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	5	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	9.85			0.00	9.85	0.00	9.85			
H8786	001	0	1	48	05	H8786_001_0	5	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	5	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	7	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	6.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8797	002	0	1	01	01	H8797_002_0	7	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												
H8797	002	0	1	01	01	H8797_002_0	7	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												
H8797	002	0	1	01	01	H8797_002_0	7	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												
H8797	002	0	1	01	01	H8797_002_0	7	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				797.12	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8849	001	0	1	01	01	H8849_001_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	001	0	1	01	01	H8849_001_0	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			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	8	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	001	0	1	01	01	H8849_001_0	8	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H8849	001	0	1	01	01	H8849_001_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	001	0	1	01	01	H8849_001_0	8	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	8	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	10	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	002	0	1	01	01	H8849_002_0	10	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	10	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	002	0	1	01	01	H8849_002_0	10	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																			0.00	0.00	0.00																7.50				7.50		0.25			0.00			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	10	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	10	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	10	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	10	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	10	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	003	0	1	01	01	H8849_003_0	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			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	8	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	003	0	1	01	01	H8849_003_0	8	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H8849	003	0	1	01	01	H8849_003_0	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	003	0	1	01	01	H8849_003_0	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	004	0	1	01	01	H8849_004_0	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	004	0	1	01	01	H8849_004_0	8	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	8	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	8	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	8	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	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	005	0	1	01	01	H8849_005_0	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			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	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	005	0	1	01	01	H8849_005_0	8	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	8	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	9	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					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	006	0	1	01	01	H8849_006_0	9	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	006	0	1	01	01	H8849_006_0	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	006	0	1	01	01	H8849_006_0	9	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	9	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	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H8849	008	1	1	01	01	H8849_008_1	8	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	1	1	01	01	H8849_008_1	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	1	1	01	01	H8849_008_1	8	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	8	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	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H8849	008	2	1	01	01	H8849_008_2	9	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	2	1	01	01	H8849_008_2	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	2	1	01	01	H8849_008_2	9	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	9	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	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H8849	008	3	1	01	01	H8849_008_3	8	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	3	1	01	01	H8849_008_3	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	3	1	01	01	H8849_008_3	8	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	8	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	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H8849	008	4	1	01	01	H8849_008_4	9	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	4	1	01	01	H8849_008_4	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	4	1	01	01	H8849_008_4	9	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	9	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	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H8849	008	5	1	01	01	H8849_008_5	8	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	5	1	01	01	H8849_008_5	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	5	1	01	01	H8849_008_5	8	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	8	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	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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, Select Care Drugs												
H8849	008	6	1	01	01	H8849_008_6	8	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					0.00	0.00	0.00																17.00				17.00			0.57	0.40	0.00			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	6	1	01	01	H8849_008_6	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	6	1	01	01	H8849_008_6	8	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	8	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	9	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					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	009	0	1	01	01	H8849_009_0	9	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	009	0	1	01	01	H8849_009_0	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	009	0	1	01	01	H8849_009_0	9	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	9	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	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					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												
H8849	010	1	1	01	01	H8849_010_1	6	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												
H8849	010	1	1	01	01	H8849_010_1	6	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	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	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	Select Care Drugs	4	01	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	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												
H8849	010	2	1	01	01	H8849_010_2	7	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					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												
H8849	010	2	1	01	01	H8849_010_2	7	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												
H8849	010	2	1	01	01	H8849_010_2	7	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	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	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	Select Care Drugs	4	01	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	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												
H8849	010	3	1	01	01	H8849_010_3	7	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					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												
H8849	010	3	1	01	01	H8849_010_3	7	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												
H8849	010	3	1	01	01	H8849_010_3	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	3	1	01	01	H8849_010_3	7	Select Care Drugs	4	01	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	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												
H8849	010	4	1	01	01	H8849_010_4	9	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					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												
H8849	010	4	1	01	01	H8849_010_4	9	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												
H8849	010	4	1	01	01	H8849_010_4	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	4	1	01	01	H8849_010_4	9	Select Care Drugs	4	01	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	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												
H8849	010	5	1	01	01	H8849_010_5	7	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					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												
H8849	010	5	1	01	01	H8849_010_5	7	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												
H8849	010	5	1	01	01	H8849_010_5	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	5	1	01	01	H8849_010_5	7	Select Care Drugs	4	01	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	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												
H8849	010	6	1	01	01	H8849_010_6	7	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					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												
H8849	010	6	1	01	01	H8849_010_6	7	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												
H8849	010	6	1	01	01	H8849_010_6	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	6	1	01	01	H8849_010_6	7	Select Care Drugs	4	01	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	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												
H8849	011	1	1	01	01	H8849_011_1	6	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					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												
H8849	011	1	1	01	01	H8849_011_1	6	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												
H8849	011	1	1	01	01	H8849_011_1	6	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	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	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	Select Care Drugs	4	01	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	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												
H8849	011	2	1	01	01	H8849_011_2	7	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					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												
H8849	011	2	1	01	01	H8849_011_2	7	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												
H8849	011	2	1	01	01	H8849_011_2	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	2	1	01	01	H8849_011_2	7	Select Care Drugs	4	01	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	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												
H8849	011	3	1	01	01	H8849_011_3	9	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					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												
H8849	011	3	1	01	01	H8849_011_3	9	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												
H8849	011	3	1	01	01	H8849_011_3	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	3	1	01	01	H8849_011_3	9	Select Care Drugs	4	01	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	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												
H8849	011	4	1	01	01	H8849_011_4	9	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					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												
H8849	011	4	1	01	01	H8849_011_4	9	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												
H8849	011	4	1	01	01	H8849_011_4	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	4	1	01	01	H8849_011_4	9	Select Care Drugs	4	01	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	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												
H8849	011	5	1	01	01	H8849_011_5	7	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					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												
H8849	011	5	1	01	01	H8849_011_5	7	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												
H8849	011	5	1	01	01	H8849_011_5	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	5	1	01	01	H8849_011_5	7	Select Care Drugs	4	01	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	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												
H8849	011	6	1	01	01	H8849_011_6	7	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					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												
H8849	011	6	1	01	01	H8849_011_6	7	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												
H8849	011	6	1	01	01	H8849_011_6	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	6	1	01	01	H8849_011_6	7	Select Care Drugs	4	01	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	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												
H8849	012	0	1	01	01	H8849_012_0	10	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	012	0	1	01	01	H8849_012_0	10	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	012	0	1	01	01	H8849_012_0	10	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	012	0	1	01	01	H8849_012_0	10	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	012	0	1	01	01	H8849_012_0	10	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	012	0	1	01	01	H8849_012_0	10	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	012	0	1	01	01	H8849_012_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	012	0	1	01	01	H8849_012_0	10	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	012	0	1	01	01	H8849_012_0	10	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	013	0	1	01	01	H8849_013_0	8	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	013	0	1	01	01	H8849_013_0	8	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	013	0	1	01	01	H8849_013_0	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	013	0	1	01	01	H8849_013_0	8	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					0.00	0.00	0.00																12.50				12.50			0.42	0.25	0.00			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	013	0	1	01	01	H8849_013_0	8	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	013	0	1	01	01	H8849_013_0	8	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	013	0	1	01	01	H8849_013_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	013	0	1	01	01	H8849_013_0	8	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	013	0	1	01	01	H8849_013_0	8	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	
H8889	001	0	1	04	01	H8889_001_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
H8889	001	0	1	04	01	H8889_001_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				10.00			0.67	0.33		0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	001	0	1	04	01	H8889_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00			1.57	1.57		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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											101.98	50	50	50				90.87	50	50	50										50	50	50				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	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												
H8889	002	0	1	04	01	H8889_002_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	002	0	1	04	01	H8889_002_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				10.00			0.67	0.33		0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	002	0	1	04	01	H8889_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00			1.57	1.57		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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.33	50	50	50				95.27	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	002	0	1	04	01	H8889_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	003	0	1	04	01	H8889_003_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	003	0	1	04	01	H8889_003_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				10.00			0.67	0.33		0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	003	0	1	04	01	H8889_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00			1.57	1.57		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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											76.79	50	50	50				73.52	50	50	50										50	50	50				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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	004	0	1	04	01	H8889_004_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											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												
H8889	004	0	1	04	01	H8889_004_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				10.00			0.67	0.33		0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	004	0	1	04	01	H8889_004_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00			1.57	1.57		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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.08	50	50	50				88.36	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	004	0	1	04	01	H8889_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	005	0	1	04	01	H8889_005_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	005	0	1	04	01	H8889_005_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				10.00			0.67	0.33		0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	005	0	1	04	01	H8889_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00			1.57	1.57		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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											103.12	50	50	50				95.80	50	50	50										50	50	50				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	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												
H8889	008	0	1	04	01	H8889_008_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				0.00			0.50	0.00		0.50	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	008	0	1	04	01	H8889_008_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					14.00	28.00	42.00											20.00	40.00	60.00				14.00	28.00	32.00				20.00				14.00			0.67	0.47		0.67	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	008	0	1	04	01	H8889_008_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	008	0	1	04	01	H8889_008_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.72	50	50	50				91.86	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	008	0	1	04	01	H8889_008_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												
H8908	001	0	1	01	01	H8908_001_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	01	01	H8908_004_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	01	01	H8908_004_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	01	01	H8908_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	01	01	H8908_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	005	0	1	01	01	H8908_005_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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												
H8908	005	0	1	01	01	H8908_005_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	005	0	1	01	01	H8908_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	005	0	1	01	01	H8908_005_0	4	Specialty Tier	4	11	1	1	5	1		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	6	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	001	0	1	01	01	H8961_001_0	6	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		1
H8961	001	0	1	01	01	H8961_001_0	6	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	001	0	1	01	01	H8961_001_0	6	Generic	4	11	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8961	001	0	1	01	01	H8961_001_0	6	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				25.00		0.83			0.83			0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	001	0	1	01	01	H8961_001_0	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				775.27	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	002	0	1	01	01	H8961_002_0	7	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		90				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	002	0	1	01	01	H8961_002_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		1
H8961	002	0	1	01	01	H8961_002_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	002	0	1	01	01	H8961_002_0	7	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				25.00		0.83			0.83			0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	002	0	1	01	01	H8961_002_0	7	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	002	0	1	01	01	H8961_002_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				775.29	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	003	0	1	01	01	H8961_003_0	7	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		90				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	003	0	1	01	01	H8961_003_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		1
H8961	003	0	1	01	01	H8961_003_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	003	0	1	01	01	H8961_003_0	7	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				25.00		0.83			0.83			0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	003	0	1	01	01	H8961_003_0	7	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	003	0	1	01	01	H8961_003_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				559.12	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8967	002	0	1	01	01	H8967_002_0	9	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 Drug, Specialty Tier												
H8967	002	0	1	01	01	H8967_002_0	9	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	10.00	20.00	30.00																																						10.00			10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8967	002	0	1	01	01	H8967_002_0	9	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 Drug, Specialty Tier												
H8967	002	0	1	01	01	H8967_002_0	9	Non-Preferred Drug	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 Drug, Specialty Tier												
H8967	002	0	1	01	01	H8967_002_0	9	Specialty Tier	4	11	1	1	5	1	111		10			1	30	60	90				2	2								10	31					33	33	33																																				33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9001	030	14	1	01	01	H9001_030_14	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	030	14	1	01	01	H9001_030_14	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	14	1	01	01	H9001_030_14	4	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	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	14	1	01	01	H9001_030_14	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	15	1	01	01	H9001_030_15	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	030	15	1	01	01	H9001_030_15	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	15	1	01	01	H9001_030_15	4	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	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	15	1	01	01	H9001_030_15	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	16	1	01	01	H9001_030_16	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	030	16	1	01	01	H9001_030_16	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	16	1	01	01	H9001_030_16	4	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	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	16	1	01	01	H9001_030_16	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	17	1	01	01	H9001_030_17	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	030	17	1	01	01	H9001_030_17	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	17	1	01	01	H9001_030_17	4	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	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	17	1	01	01	H9001_030_17	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	14	1	01	01	H9001_031_14	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	031	14	1	01	01	H9001_031_14	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	14	1	01	01	H9001_031_14	4	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	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	14	1	01	01	H9001_031_14	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	15	1	01	01	H9001_031_15	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	031	15	1	01	01	H9001_031_15	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	15	1	01	01	H9001_031_15	4	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	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	15	1	01	01	H9001_031_15	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	16	1	01	01	H9001_031_16	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	031	16	1	01	01	H9001_031_16	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	16	1	01	01	H9001_031_16	4	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	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	16	1	01	01	H9001_031_16	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	17	1	01	01	H9001_031_17	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	031	17	1	01	01	H9001_031_17	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	17	1	01	01	H9001_031_17	4	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	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	17	1	01	01	H9001_031_17	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	14	1	01	01	H9001_032_14	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	032	14	1	01	01	H9001_032_14	4	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																			9.00	18.00	18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	14	1	01	01	H9001_032_14	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	42.00	84.00	126.00																			42.00	84.00	84.00																42.00				42.00		1.40			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	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		3.17			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	14	1	01	01	H9001_032_14	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	15	1	01	01	H9001_032_15	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	032	15	1	01	01	H9001_032_15	4	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																			9.00	18.00	18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	15	1	01	01	H9001_032_15	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	42.00	84.00	126.00																			42.00	84.00	84.00																42.00				42.00		1.40			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	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		3.17			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	15	1	01	01	H9001_032_15	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	16	1	01	01	H9001_032_16	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	032	16	1	01	01	H9001_032_16	4	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																			9.00	18.00	18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	16	1	01	01	H9001_032_16	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	42.00	84.00	126.00																			42.00	84.00	84.00																42.00				42.00		1.40			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	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		3.17			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	16	1	01	01	H9001_032_16	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	17	1	01	01	H9001_032_17	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	032	17	1	01	01	H9001_032_17	4	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																			9.00	18.00	18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	17	1	01	01	H9001_032_17	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	42.00	84.00	126.00																			42.00	84.00	84.00																42.00				42.00		1.40			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	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		3.17			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	17	1	01	01	H9001_032_17	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	14	1	01	01	H9001_034_14	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	034	14	1	01	01	H9001_034_14	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	14	1	01	01	H9001_034_14	4	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	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	14	1	01	01	H9001_034_14	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	15	1	01	01	H9001_034_15	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	034	15	1	01	01	H9001_034_15	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	15	1	01	01	H9001_034_15	4	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	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	15	1	01	01	H9001_034_15	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	16	1	01	01	H9001_034_16	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	034	16	1	01	01	H9001_034_16	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	16	1	01	01	H9001_034_16	4	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	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	16	1	01	01	H9001_034_16	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	17	1	01	01	H9001_034_17	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	034	17	1	01	01	H9001_034_17	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	17	1	01	01	H9001_034_17	4	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	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	17	1	01	01	H9001_034_17	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	035	0	1	01	01	H9001_035_0	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	035	0	1	01	01	H9001_035_0	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	035	0	1	01	01	H9001_035_0	4	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	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	035	0	1	01	01	H9001_035_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	036	0	1	01	01	H9001_036_0	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	036	0	1	01	01	H9001_036_0	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	036	0	1	01	01	H9001_036_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	37.00	74.00	111.00																			37.00	74.00	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	036	0	1	01	01	H9001_036_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	037	0	1	01	01	H9001_037_0	4	Preferred Generic	4	11	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, Select Care Drugs												
H9001	037	0	1	01	01	H9001_037_0	4	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	037	0	1	01	01	H9001_037_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	37.00	74.00	111.00																			37.00	74.00	74.00																37.00				37.00		1.23			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	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	172.00																86.00				86.00		2.87			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	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	037	0	1	01	01	H9001_037_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9003	001	0	1	01	01	H9003_001_0	8	Preferred Generic	4	11	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	8	Preferred Generic	4	11	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	8	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	8	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	8	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	8	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	8	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 Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	8	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	01	01	H9003_006_0	8	Preferred Generic	4	11	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	8	Preferred Generic	4	11	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	8	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	8	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	8	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	8	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	8	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 Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	8	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	007	0	1	01	01	H9003_007_0	8	Preferred Generic	4	11	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	8	Preferred Generic	4	11	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	8	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	8	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	01	01	H9003_007_0	8	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	8	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31												30	30	30					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	8	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	01	01	H9003_007_0	8	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	008	0	1	01	01	H9003_008_0	8	Preferred Generic	4	11	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	8	Preferred Generic	4	11	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	8	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	8	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	01	01	H9003_008_0	8	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	8	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	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	8	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	01	01	H9003_008_0	8	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	009	0	1	01	01	H9003_009_0	8	Preferred Generic	4	11	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	8	Preferred Generic	4	11	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	8	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	8	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	8	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	8	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	8	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 Brand, Specialty Tier, Vaccines												
H9003	009	0	1	01	01	H9003_009_0	8	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	009	0	1	01	01	H9003_009_0	8	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9042	001	1	1	04	01	H9042_001_1	7	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	7	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	7	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					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	7	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					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	7	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	7	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	7	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	7	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					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	7	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					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	7	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	6	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					1.00	2.00	2.40					1.00	2.00	2.40																12.00				12.00			0.40	0.03	0.03			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	013	0	2	01	01	H9047_013_0	6	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					1.00	2.00	2.40					1.00	2.00	2.40																12.00				12.00			0.40	0.03	0.03			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H9047	013	0	2	01	01	H9047_013_0	6	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, Vaccines												
H9047	013	0	2	01	01	H9047_013_0	6	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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, Vaccines												
H9047	013	0	2	01	01	H9047_013_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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, Vaccines												
H9047	013	0	2	01	01	H9047_013_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											980.25	33						980.25	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	013	0	2	01	01	H9047_013_0	6	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	037	0	1	01	01	H9047_037_0	7	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, Vaccines												
H9047	037	0	1	01	01	H9047_037_0	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Vaccines												
H9047	037	0	1	01	01	H9047_037_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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, Vaccines												
H9047	037	0	1	01	01	H9047_037_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	037	0	1	01	01	H9047_037_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											759.60	30						759.60	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	037	0	1	01	01	H9047_037_0	7	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	038	0	1	02	01	H9047_038_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					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, Vaccines												
H9047	038	0	1	02	01	H9047_038_0	8	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, Vaccines										1		
H9047	038	0	1	02	01	H9047_038_0	8	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Vaccines												
H9047	038	0	1	02	01	H9047_038_0	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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, Vaccines												
H9047	038	0	1	02	01	H9047_038_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	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, Vaccines												
H9047	038	0	1	02	01	H9047_038_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											920.88	30						920.88	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	038	0	1	02	01	H9047_038_0	8	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	039	0	1	02	01	H9047_039_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					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, Vaccines												
H9047	039	0	1	02	01	H9047_039_0	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Vaccines												
H9047	039	0	1	02	01	H9047_039_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	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, Vaccines												
H9047	039	0	1	02	01	H9047_039_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	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, Vaccines												
H9047	039	0	1	02	01	H9047_039_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											974.63	33						974.63	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	039	0	1	02	01	H9047_039_0	7	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	045	0	1	01	01	H9047_045_0	7	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	25.00					5.00	10.00	12.50					5.00	10.00	12.50																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	045	0	1	01	01	H9047_045_0	7	Generic	3	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	045	0	1	01	01	H9047_045_0	7	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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, Vaccines												
H9047	045	0	1	01	01	H9047_045_0	7	Non-Preferred Drug	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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												
H9047	045	0	1	01	01	H9047_045_0	7	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											649.12	25						649.12	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	045	0	1	01	01	H9047_045_0	7	Vaccines	3	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	047	0	1	02	01	H9047_047_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	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, Vaccines												
H9047	047	0	1	02	01	H9047_047_0	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	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, Vaccines												
H9047	047	0	1	02	01	H9047_047_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	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, Vaccines												
H9047	047	0	1	02	01	H9047_047_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	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, Vaccines												
H9047	047	0	1	02	01	H9047_047_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											761.37	28						761.37	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	047	0	1	02	01	H9047_047_0	7	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	049	0	1	01	01	H9047_049_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	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, Vaccines												
H9047	049	0	1	01	01	H9047_049_0	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Vaccines												
H9047	049	0	1	01	01	H9047_049_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	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, Vaccines												
H9047	049	0	1	01	01	H9047_049_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	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, Vaccines												
H9047	049	0	1	01	01	H9047_049_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											698.60	28						698.60	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	049	0	1	01	01	H9047_049_0	7	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	054	0	1	01	01	H9047_054_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	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, Vaccines												
H9047	054	0	1	01	01	H9047_054_0	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Vaccines												
H9047	054	0	1	01	01	H9047_054_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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, Vaccines												
H9047	054	0	1	01	01	H9047_054_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	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												
H9047	054	0	1	01	01	H9047_054_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											692.93	29						692.93	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	054	0	1	01	01	H9047_054_0	7	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	055	1	1	01	01	H9047_055_1	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					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, Vaccines												
H9047	055	1	1	01	01	H9047_055_1	7	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, Vaccines										1		
H9047	055	1	1	01	01	H9047_055_1	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Vaccines												
H9047	055	1	1	01	01	H9047_055_1	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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, Vaccines												
H9047	055	1	1	01	01	H9047_055_1	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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, Vaccines												
H9047	055	1	1	01	01	H9047_055_1	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											853.02	33						853.02	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	055	1	1	01	01	H9047_055_1	7	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	055	2	1	01	01	H9047_055_2	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					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, Vaccines												
H9047	055	2	1	01	01	H9047_055_2	7	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, Vaccines										1		
H9047	055	2	1	01	01	H9047_055_2	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Vaccines												
H9047	055	2	1	01	01	H9047_055_2	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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, Vaccines												
H9047	055	2	1	01	01	H9047_055_2	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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, Vaccines												
H9047	055	2	1	01	01	H9047_055_2	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											853.02	33						853.02	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	055	2	1	01	01	H9047_055_2	7	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	056	1	1	02	01	H9047_056_1	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					4.00	8.00	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, Vaccines												
H9047	056	1	1	02	01	H9047_056_1	7	Preferred Generic	4	01	1	2	1	3		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, Vaccines										1		
H9047	056	1	1	02	01	H9047_056_1	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Vaccines												
H9047	056	1	1	02	01	H9047_056_1	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	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, Vaccines												
H9047	056	1	1	02	01	H9047_056_1	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	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, Vaccines												
H9047	056	1	1	02	01	H9047_056_1	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											794.92	28						794.92	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	056	1	1	02	01	H9047_056_1	7	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	056	2	1	02	01	H9047_056_2	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					4.00	8.00	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, Vaccines												
H9047	056	2	1	02	01	H9047_056_2	7	Preferred Generic	4	01	1	2	1	3		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, Vaccines										1		
H9047	056	2	1	02	01	H9047_056_2	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Vaccines												
H9047	056	2	1	02	01	H9047_056_2	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	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, Vaccines												
H9047	056	2	1	02	01	H9047_056_2	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	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, Vaccines												
H9047	056	2	1	02	01	H9047_056_2	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											794.92	28						794.92	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	056	2	1	02	01	H9047_056_2	7	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	059	0	1	02	01	H9047_059_0	7	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, Vaccines												
H9047	059	0	1	02	01	H9047_059_0	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Vaccines												
H9047	059	0	1	02	01	H9047_059_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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, Vaccines												
H9047	059	0	1	02	01	H9047_059_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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												
H9047	059	0	1	02	01	H9047_059_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											819.66	33						819.66	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	059	0	1	02	01	H9047_059_0	7	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	060	0	1	02	01	H9047_060_0	7	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, Vaccines												
H9047	060	0	1	02	01	H9047_060_0	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Vaccines												
H9047	060	0	1	02	01	H9047_060_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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, Vaccines												
H9047	060	0	1	02	01	H9047_060_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	060	0	1	02	01	H9047_060_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											973.42	33						973.42	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	060	0	1	02	01	H9047_060_0	7	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	062	0	1	02	01	H9047_062_0	7	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, Vaccines												
H9047	062	0	1	02	01	H9047_062_0	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Vaccines												
H9047	062	0	1	02	01	H9047_062_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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, Vaccines												
H9047	062	0	1	02	01	H9047_062_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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												
H9047	062	0	1	02	01	H9047_062_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											913.30	33						913.30	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	062	0	1	02	01	H9047_062_0	7	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	063	0	1	01	01	H9047_063_0	7	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, Vaccines												
H9047	063	0	1	01	01	H9047_063_0	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Vaccines												
H9047	063	0	1	01	01	H9047_063_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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, Vaccines												
H9047	063	0	1	01	01	H9047_063_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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												
H9047	063	0	1	01	01	H9047_063_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											742.52	29						742.52	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	063	0	1	01	01	H9047_063_0	7	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9065	001	0	1	01	01	H9065_001_0	7	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					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												
H9065	001	0	1	01	01	H9065_001_0	7	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												
H9065	001	0	1	01	01	H9065_001_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	001	0	1	01	01	H9065_001_0	7	Select Care Drugs	4	01	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	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												
H9065	002	0	1	02	01	H9065_002_0	7	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	7	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	7	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, Select Care Drugs												
H9065	002	0	1	02	01	H9065_002_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	002	0	1	02	01	H9065_002_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H9065	002	0	1	02	01	H9065_002_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	002	0	1	02	01	H9065_002_0	7	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	7	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	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					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												
H9065	003	0	1	02	01	H9065_003_0	6	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			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	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	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	Specialty Tier	4	11	1	1	5	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	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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												
H9065	004	0	1	02	01	H9065_004_0	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	004	0	1	02	01	H9065_004_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	004	0	1	02	01	H9065_004_0	7	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	7	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	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	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	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					0.00	0.00	0.00																16.00				16.00			0.53	0.53	0.00			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	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	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	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	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	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	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	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	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					0.00	0.00	0.00																16.00				16.00			0.53	0.53	0.00			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	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	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	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	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	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	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	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	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					0.00	0.00	0.00																16.00				16.00			0.53	0.53	0.00			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	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	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	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	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	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	7	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					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												
H9065	008	0	1	01	01	H9065_008_0	7	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	008	0	1	01	01	H9065_008_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	008	0	1	01	01	H9065_008_0	7	Preferred Brand	4	11	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	70.00	105.00					35.00	70.00	70.00																35.00				35.00			1.17	1.17	1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H9065	008	0	1	01	01	H9065_008_0	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	008	0	1	01	01	H9065_008_0	7	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	7	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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	002	0	1	04	01	H9070_002_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	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												
H9070	002	0	1	04	01	H9070_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	002	0	1	04	01	H9070_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	003	0	1	04	01	H9070_003_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	003	0	1	04	01	H9070_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	004	0	1	04	01	H9070_004_0	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	004	0	1	04	01	H9070_004_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	004	0	1	04	01	H9070_004_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	005	0	1	04	01	H9070_005_0	5	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	005	0	1	04	01	H9070_005_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	005	0	1	04	01	H9070_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	005	0	1	04	01	H9070_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	1	1	04	01	H9070_006_1	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	1	1	04	01	H9070_006_1	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	1	1	04	01	H9070_006_1	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	3	1	04	01	H9070_006_3	6	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	3	1	04	01	H9070_006_3	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	3	1	04	01	H9070_006_3	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9078	001	0	1	01	01	H9078_001_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9078	001	0	1	01	01	H9078_001_0	7	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9078	001	0	1	01	01	H9078_001_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								20.00		60.00					15.00		30.00											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												
H9078	001	0	1	01	01	H9078_001_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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												
H9078	001	0	1	01	01	H9078_001_0	7	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	
H9078	001	0	1	01	01	H9078_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		100	1	1				30		100	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		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												
H9078	001	0	1	01	01	H9078_001_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9078	003	0	1	01	01	H9078_003_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9078	003	0	1	01	01	H9078_003_0	7	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9078	003	0	1	01	01	H9078_003_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								20.00		60.00					15.00		30.00											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												
H9078	003	0	1	01	01	H9078_003_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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												
H9078	003	0	1	01	01	H9078_003_0	7	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	
H9078	003	0	1	01	01	H9078_003_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		100	1	1				30		100	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		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												
H9078	003	0	1	01	01	H9078_003_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9078	007	0	1	01	01	H9078_007_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	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												
H9078	007	0	1	01	01	H9078_007_0	7	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	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										1		
H9078	007	0	1	01	01	H9078_007_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9078	007	0	1	01	01	H9078_007_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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												
H9078	007	0	1	01	01	H9078_007_0	7	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	
H9078	007	0	1	01	01	H9078_007_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		100	1	1				30		100	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		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												
H9078	007	0	1	01	01	H9078_007_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9078	008	0	1	01	01	H9078_008_0	8	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	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												
H9078	008	0	1	01	01	H9078_008_0	8	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	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										1		
H9078	008	0	1	01	01	H9078_008_0	8	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9078	008	0	1	01	01	H9078_008_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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												
H9078	008	0	1	01	01	H9078_008_0	8	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	
H9078	008	0	1	01	01	H9078_008_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		100	1	1				30		100	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		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												
H9078	008	0	1	01	01	H9078_008_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9078	009	0	1	01	01	H9078_009_0	7	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	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												
H9078	009	0	1	01	01	H9078_009_0	7	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	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										1		
H9078	009	0	1	01	01	H9078_009_0	7	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9078	009	0	1	01	01	H9078_009_0	7	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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												
H9078	009	0	1	01	01	H9078_009_0	7	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	
H9078	009	0	1	01	01	H9078_009_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		100	1	1				30		100	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		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												
H9078	009	0	1	01	01	H9078_009_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9078	010	0	1	01	01	H9078_010_0	8	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		100	1	1				30		100	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												
H9078	010	0	1	01	01	H9078_010_0	8	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		100	1	1				30		100	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										1		
H9078	010	0	1	01	01	H9078_010_0	8	Generic	4	11	1	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								10.00		30.00					5.00		10.00											10.00		30.00				5.00		10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9078	010	0	1	01	01	H9078_010_0	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		100	1	1				30		100	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												
H9078	010	0	1	01	01	H9078_010_0	8	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		100	1	1				30		100	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	
H9078	010	0	1	01	01	H9078_010_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		100	1	1				30		100	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		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												
H9078	010	0	1	01	01	H9078_010_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	009	0	1	01	01	H9082_009_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	009	0	1	01	01	H9082_009_0	5	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	5	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	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.75	32	32	32																		32	32	32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	009	0	1	01	01	H9082_009_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				644.87	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	010	0	1	01	01	H9082_010_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9082	010	0	1	01	01	H9082_010_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9082	010	0	1	01	01	H9082_010_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9082	010	0	1	01	01	H9082_010_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9082	010	0	1	01	01	H9082_010_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				973.87	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9082	010	0	1	01	01	H9082_010_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9082	011	0	1	01	01	H9082_011_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.48			0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9082	011	0	1	01	01	H9082_011_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.65			0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9082	011	0	1	01	01	H9082_011_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9082	011	0	1	01	01	H9082_011_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9082	011	0	1	01	01	H9082_011_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				796.41	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9082	011	0	1	01	01	H9082_011_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	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 Drug, Specialty Tier, Select Care Drugs												
H9096	001	0	1	02	01	H9096_001_0	7	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								7.00	14.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	7	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																	12.00			12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	7	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					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, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	7	Non-Preferred Drug	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					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, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	7	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 Drug, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	7	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 Drug, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	7	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 Drug, Specialty Tier, Vaccines										1		
H9096	002	0	1	02	01	H9096_002_0	7	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								7.00	14.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																	12.00			12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					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, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7	Non-Preferred Drug	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					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, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7	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 Drug, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7	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 Drug, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7	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 Drug, Specialty Tier, Vaccines										1		
H9096	004	0	1	01	01	H9096_004_0	7	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					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, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																	12.00			12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					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, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7	Non-Preferred Drug	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					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, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7	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 Drug, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7	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 Drug, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7	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 Drug, Specialty Tier, Vaccines										1		
H9096	005	0	1	01	01	H9096_005_0	7	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								7.00	14.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																	12.00			12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								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, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7	Non-Preferred Drug	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					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, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7	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 Drug, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7	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 Drug, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7	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 Drug, Specialty Tier, Vaccines										1		
H9096	006	0	1	02	01	H9096_006_0	7	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					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, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	7	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																	12.00			12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	7	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					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, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	7	Non-Preferred Drug	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					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, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	7	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 Drug, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	7	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 Drug, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	7	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 Drug, Specialty Tier, Vaccines										1		
H9096	012	0	1	02	01	H9096_012_0	7	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					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, Vaccines												
H9096	012	0	1	02	01	H9096_012_0	7	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																	12.00			12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	012	0	1	02	01	H9096_012_0	7	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					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, Vaccines												
H9096	012	0	1	02	01	H9096_012_0	7	Non-Preferred Drug	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					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, Vaccines												
H9096	012	0	1	02	01	H9096_012_0	7	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 Drug, Specialty Tier, Vaccines												
H9096	012	0	1	02	01	H9096_012_0	7	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 Drug, Specialty Tier, Vaccines												
H9096	012	0	1	02	01	H9096_012_0	7	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 Drug, Specialty Tier, Vaccines										1		
H9104	006	0	1	01	01	H9104_006_0	5	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	5	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	5	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					0.00	0.00	0.00											12.00	24.00	36.00				0.00	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												
H9104	006	0	1	01	01	H9104_006_0	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9147	001	0	1	01	01	H9147_001_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				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												
H9147	001	0	1	01	01	H9147_001_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					18.00	36.00	54.00											20.00	40.00	60.00				18.00	36.00	54.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9147	001	0	1	01	01	H9147_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H9147	001	0	1	01	01	H9147_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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 Care Drugs												
H9147	001	0	1	01	01	H9147_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9147	001	0	1	01	01	H9147_001_0	5	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9147	001	0	1	01	01	H9147_001_0	5	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9207	002	0	1	02	01	H9207_002_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	002	0	1	02	01	H9207_002_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	25.00																			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	5	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	94.00																47.00				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	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	250.00																			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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1063.71	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	012	0	1	02	01	H9207_012_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	25.00																			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	5	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	94.00																47.00				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	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	250.00																			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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1188.65	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9219	001	0	1	04	01	H9219_001_0	7	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					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			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	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			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	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	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	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												
H9219	001	0	1	04	01	H9219_001_0	7	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	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	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					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			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	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					0.00	0.00	0.00																15.00				15.00			0.50	0.33	0.00			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	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	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	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												
H9219	002	0	1	04	01	H9219_002_0	6	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	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		
H9239	001	0	1	48	05	H9239_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			
H9239	001	0	1	48	05	H9239_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			
H9239	001	0	1	48	05	H9239_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			
H9258	001	0	1	01	01	H9258_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9258	001	0	1	01	01	H9258_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H9258	001	0	1	01	01	H9258_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9258	001	0	1	01	01	H9258_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.11	47	47	47				94.89	45	45	45										47	47	47				45	45	45			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9258	001	0	1	01	01	H9258_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9258	001	0	1	01	01	H9258_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9302	003	0	1	01	01	H9302_003_0	7	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	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	7	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	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	Preferred Brand	4	11	1	2	3	1		111	01	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	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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												
H9302	007	0	1	01	01	H9302_007_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	8	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	8	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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	8	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	8	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												
H9306	001	0	1	01	01	H9306_001_0	6	Preferred Generic	4	11	1	2	1	1	110		10	110		1	30		90				2	2	30		90					10	31	3.00		0.00																			3.00		0.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9306	001	0	1	01	01	H9306_001_0	6	Generic	4	11	1	2	2	1	110		10	110		1	30		90				2	2	30		90					10	31	8.00		8.00																			8.00		8.00																	8.00			8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9306	001	0	1	01	01	H9306_001_0	6	Preferred Brand	4	11	1	2	3	1	110		10	110		1	30		90				2	2	30		90					10	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												
H9306	001	0	1	01	01	H9306_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		10	110		1	30		90				2	2	30		90					10	31	100.00		300.00																			100.00		300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9306	001	0	1	01	01	H9306_001_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				112.29	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9306	002	0	1	01	01	H9306_002_0	7	Preferred Generic	4	11	1	2	1	1	110		10	110		1	30		90				2	2	30		90					10	31	0.00		0.00																			0.00		0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H9306	002	0	1	01	01	H9306_002_0	7	Generic	4	11	1	2	2	1	110		10	110		1	30		90				2	2	30		90					10	31	0.00		0.00																			0.00		0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H9306	002	0	1	01	01	H9306_002_0	7	Preferred Brand	4	11	1	2	3	1	110		10	110		1	30		90				2	2	30		90					10	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, Supplemental Drugs												
H9306	002	0	1	01	01	H9306_002_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		10	110		1	30		90				2	2	30		90					10	31	100.00		300.00																			100.00		300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H9306	002	0	1	01	01	H9306_002_0	7	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				105.83	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H9306	002	0	1	01	01	H9306_002_0	7	Supplemental Drugs	4	01	2	2	6	1	010		10	010		1	30								30							10	31	10.00																					10.00																			10.00			10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H9335	001	0	1	01	01	H9335_001_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	001	0	1	01	01	H9335_001_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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, Select Care Drugs												
H9335	001	0	1	01	01	H9335_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H9335	001	0	1	01	01	H9335_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.45	47	47	47				95.22	45	45	45										47	47	47				45	45	45			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	001	0	1	01	01	H9335_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	001	0	1	01	01	H9335_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	003	0	1	01	01	H9335_003_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	003	0	1	01	01	H9335_003_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	8.00	16.00	24.00																									8.00	16.00	24.00				8.00	16.00	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	003	0	1	01	01	H9335_003_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	003	0	1	01	01	H9335_003_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.12	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	003	0	1	01	01	H9335_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	003	0	1	01	01	H9335_003_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	005	0	1	01	01	H9335_005_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	005	0	1	01	01	H9335_005_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	005	0	1	01	01	H9335_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H9335	005	0	1	01	01	H9335_005_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											96.62	50	50	50				92.75	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	005	0	1	01	01	H9335_005_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	005	0	1	01	01	H9335_005_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	006	0	1	01	01	H9335_006_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	006	0	1	01	01	H9335_006_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	006	0	1	01	01	H9335_006_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H9335	006	0	1	01	01	H9335_006_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.81	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	006	0	1	01	01	H9335_006_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	006	0	1	01	01	H9335_006_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9357	001	0	1	04	01	H9357_001_0	3	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9357	001	0	1	04	01	H9357_001_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H9357	001	0	1	04	01	H9357_001_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H9357	001	0	1	04	01	H9357_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H9357	001	0	1	04	01	H9357_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9357	001	0	1	04	01	H9357_001_0	3	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9357	002	0	1	04	01	H9357_002_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9357	002	0	1	04	01	H9357_002_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H9357	002	0	1	04	01	H9357_002_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9357	002	0	1	04	01	H9357_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H9357	002	0	1	04	01	H9357_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9357	002	0	1	04	01	H9357_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9357	003	0	1	04	01	H9357_003_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9357	003	0	1	04	01	H9357_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H9357	003	0	1	04	01	H9357_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9357	003	0	1	04	01	H9357_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H9357	003	0	1	04	01	H9357_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9357	003	0	1	04	01	H9357_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9357	004	0	1	04	01	H9357_004_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9357	004	0	1	04	01	H9357_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H9357	004	0	1	04	01	H9357_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9357	004	0	1	04	01	H9357_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H9357	004	0	1	04	01	H9357_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9357	004	0	1	04	01	H9357_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	001	0	1	01	01	H9364_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	001	0	1	01	01	H9364_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H9364	001	0	1	01	01	H9364_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9364	001	0	1	01	01	H9364_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.27	46	46	46				94.00	44	44	44										46	46	46				44	44	44			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	001	0	1	01	01	H9364_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	001	0	1	01	01	H9364_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	002	0	1	01	01	H9364_002_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	002	0	1	01	01	H9364_002_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	9.00	18.00	27.00																									9.00	18.00	27.00				9.00	18.00	0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	002	0	1	01	01	H9364_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H9364	002	0	1	01	01	H9364_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.77	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	002	0	1	01	01	H9364_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	002	0	1	01	01	H9364_002_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	003	0	1	01	01	H9364_003_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	003	0	1	01	01	H9364_003_0	5	Generic	4	11	1	2	2	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	6.00	0.00				3.00				3.00		0.1				0.1	0.1	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	003	0	1	01	01	H9364_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	120.00																									40.00	80.00	120.00				40.00	80.00	80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	003	0	1	01	01	H9364_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.30	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	003	0	1	01	01	H9364_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	003	0	1	01	01	H9364_003_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	004	0	1	01	01	H9364_004_0	5	Preferred Generic	4	11	3	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			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	004	0	1	01	01	H9364_004_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H9364	004	0	1	01	01	H9364_004_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9364	004	0	1	01	01	H9364_004_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.46	50	50	50				93.57	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	004	0	1	01	01	H9364_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9364	004	0	1	01	01	H9364_004_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9387	001	0	1	04	01	H9387_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9387	001	0	1	04	01	H9387_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	42.00				9.00	18.00	0.00				14.00				14.00			0.47	0.3		0.47	0.3	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9387	001	0	1	04	01	H9387_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9387	001	0	1	04	01	H9387_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H9387	001	0	1	04	01	H9387_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9387	001	0	1	04	01	H9387_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9387	003	0	1	04	01	H9387_003_0	5	Preferred Generic	4	11	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											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, Select Care Drugs												
H9387	003	0	1	04	01	H9387_003_0	5	Preferred Generic	4	11	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											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, Select Care Drugs										1		3
H9387	003	0	1	04	01	H9387_003_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9387	003	0	1	04	01	H9387_003_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9387	003	0	1	04	01	H9387_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H9387	003	0	1	04	01	H9387_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9387	003	0	1	04	01	H9387_003_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9387	003	0	1	04	01	H9387_003_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H9403	003	0	1	01	01	H9403_003_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								5.00	10.00	5.00					0.00	0.00	0.00											5.00	10.00	5.00				0.00	0.00	0.00				0.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	003	0	1	01	01	H9403_003_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	50.00					15.00	30.00	37.50											20.00	40.00	50.00				15.00	30.00	37.50				15.00				15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	003	0	1	01	01	H9403_003_0	4	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	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	003	0	1	01	01	H9403_003_0	4	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	250.00					95.00	190.00	237.50											100.00	200.00	250.00				95.00	190.00	237.50				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	003	0	1	01	01	H9403_003_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											589.82	28	28	28				589.82	28	28	28										28	28	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	5	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								8.00	16.00	8.00					3.00	6.00	3.00											8.00	16.00	8.00				3.00	6.00	3.00				3.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	004	0	1	01	01	H9403_004_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	42.50					12.00	24.00	30.00											17.00	34.00	42.50				12.00	24.00	30.00				12.00				12.00			0.57	0.40		0.57	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	004	0	1	01	01	H9403_004_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	004	0	1	01	01	H9403_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	250.00					95.00	190.00	237.50											100.00	200.00	250.00				95.00	190.00	237.50				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	004	0	1	01	01	H9403_004_0	5	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											955.84	33	33	33				955.84	33	33	33										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	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					0.00	0.00	0.00					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, Select Care Drugs												
H9408	005	0	1	04	01	H9408_005_0	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H9408	005	0	1	04	01	H9408_005_0	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					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, Select Care Drugs												
H9408	005	0	1	04	01	H9408_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					93.00	186.00	279.00					93.00	186.00	279.00																100.00				100.00			3.33	3.10	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	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	005	0	1	04	01	H9408_005_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	1	1	04	01	H9408_006_1	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					0.00	0.00	0.00					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, Select Care Drugs												
H9408	006	1	1	04	01	H9408_006_1	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H9408	006	1	1	04	01	H9408_006_1	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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, Select Care Drugs												
H9408	006	1	1	04	01	H9408_006_1	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					93.00	186.00	279.00					93.00	186.00	279.00																100.00				100.00			3.33	3.10	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	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	1	1	04	01	H9408_006_1	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	2	1	04	01	H9408_006_2	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					0.00	0.00	0.00					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, Select Care Drugs												
H9408	006	2	1	04	01	H9408_006_2	4	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H9408	006	2	1	04	01	H9408_006_2	4	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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, Select Care Drugs												
H9408	006	2	1	04	01	H9408_006_2	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					93.00	186.00	279.00					93.00	186.00	279.00																100.00				100.00			3.33	3.10	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	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	2	1	04	01	H9408_006_2	4	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9414	001	0	1	04	01	H9414_001_0	11	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 Brand, Specialty Tier												
H9414	001	0	1	04	01	H9414_001_0	11	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	5.00	10.00	10.00																			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												
H9414	001	0	1	04	01	H9414_001_0	11	Preferred Brand	4	10	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	131.00																			47.00	94.00	131.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9414	001	0	1	04	01	H9414_001_0	11	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	290.00																			100.00	200.00	290.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9414	001	0	1	04	01	H9414_001_0	11	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9414	002	0	1	04	01	H9414_002_0	13	Preferred Generic	3	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	6.50	13.00	19.50																			6.50	13.00	19.50																6.50				6.50		0.21			0.21			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9414	002	0	1	04	01	H9414_002_0	13	Generic	3	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				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												
H9414	002	0	1	04	01	H9414_002_0	13	Preferred Brand	3	10	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			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												
H9414	002	0	1	04	01	H9414_002_0	13	Non-Preferred Brand	3	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 Brand, Specialty Tier												
H9414	002	0	1	04	01	H9414_002_0	13	Specialty Tier	3	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9428	001	0	1	04	01	H9428_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9428	001	0	1	04	01	H9428_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9428	001	0	1	04	01	H9428_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9428	001	0	1	04	01	H9428_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.36	44	44	44				93.89	42	42	42										44	44	44				42	42	42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9428	001	0	1	04	01	H9428_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9428	001	0	1	04	01	H9428_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9428	001	0	1	04	01	H9428_001_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H9428	002	0	1	04	01	H9428_002_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9428	002	0	1	04	01	H9428_002_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9428	002	0	1	04	01	H9428_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9428	002	0	1	04	01	H9428_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.14	50	50	50				90.37	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9428	002	0	1	04	01	H9428_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9428	002	0	1	04	01	H9428_002_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9428	002	0	1	04	01	H9428_002_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H9431	001	0	1	04	01	H9431_001_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	001	0	1	04	01	H9431_001_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	001	0	1	04	01	H9431_001_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	001	0	1	04	01	H9431_001_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	001	0	1	04	01	H9431_001_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	001	0	1	04	01	H9431_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	001	0	1	04	01	H9431_001_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											730.49	29						376.25	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	002	0	1	04	01	H9431_002_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	002	0	1	04	01	H9431_002_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	002	0	1	04	01	H9431_002_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H9431	002	0	1	04	01	H9431_002_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	002	0	1	04	01	H9431_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	002	0	1	04	01	H9431_002_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											985.34	33						384.34	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	004	0	1	04	01	H9431_004_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	004	0	1	04	01	H9431_004_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	004	0	1	04	01	H9431_004_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H9431	004	0	1	04	01	H9431_004_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	004	0	1	04	01	H9431_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	004	0	1	04	01	H9431_004_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1079.74	33						513.80	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	005	0	1	04	01	H9431_005_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	005	0	1	04	01	H9431_005_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	005	0	1	04	01	H9431_005_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H9431	005	0	1	04	01	H9431_005_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	005	0	1	04	01	H9431_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	005	0	1	04	01	H9431_005_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											852.48	33						426.96	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	006	0	1	04	01	H9431_006_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	006	0	1	04	01	H9431_006_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	006	0	1	04	01	H9431_006_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
H9431	006	0	1	04	01	H9431_006_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	006	0	1	04	01	H9431_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	006	0	1	04	01	H9431_006_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											914.17	33						380.99	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	009	0	1	04	01	H9431_009_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	009	0	1	04	01	H9431_009_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	009	0	1	04	01	H9431_009_0	3	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	009	0	1	04	01	H9431_009_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	009	0	1	04	01	H9431_009_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	009	0	1	04	01	H9431_009_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	009	0	1	04	01	H9431_009_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											905.19	33						462.68	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	011	0	1	04	01	H9431_011_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	011	0	1	04	01	H9431_011_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	011	0	1	04	01	H9431_011_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	011	0	1	04	01	H9431_011_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	011	0	1	04	01	H9431_011_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	011	0	1	04	01	H9431_011_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											943.05	33						459.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	013	0	1	04	01	H9431_013_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	013	0	1	04	01	H9431_013_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					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												
H9431	013	0	1	04	01	H9431_013_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	013	0	1	04	01	H9431_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	013	0	1	04	01	H9431_013_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											981.04	33						407.22	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	014	0	1	04	01	H9431_014_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	014	0	1	04	01	H9431_014_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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					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												
H9431	014	0	1	04	01	H9431_014_0	2	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		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	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	014	0	1	04	01	H9431_014_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	014	0	1	04	01	H9431_014_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											981.04	33						407.21	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3	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												
H9460	001	0	1	01	01	H9460_001_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.35	48	48	48				73.59	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											854.58	33						708.09	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9489	001	0	1	01	01	H9489_001_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					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												
H9489	001	0	1	01	01	H9489_001_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	36.00	52.00					10.00	16.00	22.00					2.00	6.00	8.00																20.00				10.00			0.67	0.33	0.07			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9489	001	0	1	01	01	H9489_001_0	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	Non-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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											950.76	29						950.76	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9525	003	0	1	01	01	H9525_003_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H9525	003	0	1	01	01	H9525_003_0	7	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												
H9525	003	0	1	01	01	H9525_003_0	7	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	120.00					40.00	120.00	120.00																40.00				40.00			1.33	1.33	1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				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												
H9525	004	0	1	01	01	H9525_004_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H9525	004	0	1	01	01	H9525_004_0	7	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					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	7	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	7	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	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					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												
H9525	006	0	1	01	01	H9525_006_0	7	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					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	7	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	7	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	9	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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												
H9525	007	0	1	01	01	H9525_007_0	9	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												
H9525	007	0	1	01	01	H9525_007_0	9	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												
H9525	007	0	1	01	01	H9525_007_0	9	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	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	007	0	1	01	01	H9525_007_0	9	Select Care Drugs	4	01	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	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												
H9525	010	0	1	01	01	H9525_010_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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												
H9525	010	0	1	01	01	H9525_010_0	7	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												
H9525	010	0	1	01	01	H9525_010_0	7	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												
H9525	010	0	1	01	01	H9525_010_0	7	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	010	0	1	01	01	H9525_010_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	010	0	1	01	01	H9525_010_0	7	Select Care Drugs	4	01	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	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												
H9525	011	0	1	01	01	H9525_011_0	9	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												
H9525	011	0	1	01	01	H9525_011_0	9	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					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	011	0	1	01	01	H9525_011_0	9	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	011	0	1	01	01	H9525_011_0	9	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	011	0	1	01	01	H9525_011_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	011	0	1	01	01	H9525_011_0	9	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	011	0	1	01	01	H9525_011_0	9	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	012	0	1	01	01	H9525_012_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	012	0	1	01	01	H9525_012_0	7	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9525	012	0	1	01	01	H9525_012_0	7	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					0.00	0.00	0.00																4.00				4.00			0.13	0.13	0.00			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	012	0	1	01	01	H9525_012_0	7	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	012	0	1	01	01	H9525_012_0	7	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	012	0	1	01	01	H9525_012_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	012	0	1	01	01	H9525_012_0	7	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	012	0	1	01	01	H9525_012_0	7	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	013	1	1	01	01	H9525_013_1	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					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												
H9525	013	1	1	01	01	H9525_013_1	7	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					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	013	1	1	01	01	H9525_013_1	7	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	013	1	1	01	01	H9525_013_1	7	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	013	1	1	01	01	H9525_013_1	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	013	1	1	01	01	H9525_013_1	7	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	013	1	1	01	01	H9525_013_1	7	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	013	2	1	01	01	H9525_013_2	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					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												
H9525	013	2	1	01	01	H9525_013_2	7	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					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	013	2	1	01	01	H9525_013_2	7	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	013	2	1	01	01	H9525_013_2	7	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	013	2	1	01	01	H9525_013_2	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	013	2	1	01	01	H9525_013_2	7	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	013	2	1	01	01	H9525_013_2	7	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	013	3	1	01	01	H9525_013_3	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					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												
H9525	013	3	1	01	01	H9525_013_3	7	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					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	013	3	1	01	01	H9525_013_3	7	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	013	3	1	01	01	H9525_013_3	7	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	013	3	1	01	01	H9525_013_3	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	013	3	1	01	01	H9525_013_3	7	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	013	3	1	01	01	H9525_013_3	7	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	013	4	1	01	01	H9525_013_4	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					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												
H9525	013	4	1	01	01	H9525_013_4	7	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					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	013	4	1	01	01	H9525_013_4	7	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	013	4	1	01	01	H9525_013_4	7	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	013	4	1	01	01	H9525_013_4	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	013	4	1	01	01	H9525_013_4	7	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	013	4	1	01	01	H9525_013_4	7	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	7	Preferred Generic	4	01	1	2	1	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												
H9572	001	1	1	04	01	H9572_001_1	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	001	1	1	04	01	H9572_001_1	7	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												
H9572	001	1	1	04	01	H9572_001_1	7	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												
H9572	001	1	1	04	01	H9572_001_1	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											67.00	48		48				64.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	7	Preferred Generic	4	01	1	2	1	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												
H9572	001	2	1	04	01	H9572_001_2	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	001	2	1	04	01	H9572_001_2	7	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												
H9572	001	2	1	04	01	H9572_001_2	7	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												
H9572	001	2	1	04	01	H9572_001_2	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											67.00	48		48				64.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	7	Preferred Generic	4	01	1	2	1	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												
H9572	001	3	1	04	01	H9572_001_3	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	001	3	1	04	01	H9572_001_3	7	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												
H9572	001	3	1	04	01	H9572_001_3	7	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												
H9572	001	3	1	04	01	H9572_001_3	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											67.00	48		48				64.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	7	Preferred Generic	4	01	1	2	1	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												
H9572	001	4	1	04	01	H9572_001_4	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	001	4	1	04	01	H9572_001_4	7	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												
H9572	001	4	1	04	01	H9572_001_4	7	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												
H9572	001	4	1	04	01	H9572_001_4	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											67.00	48		48				64.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	7	Preferred Generic	4	01	1	2	1	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												
H9572	001	6	1	04	01	H9572_001_6	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	001	6	1	04	01	H9572_001_6	7	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												
H9572	001	6	1	04	01	H9572_001_6	7	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												
H9572	001	6	1	04	01	H9572_001_6	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											67.00	48		48				64.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	002	1	1	04	01	H9572_002_1	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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												
H9572	002	1	1	04	01	H9572_002_1	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	002	1	1	04	01	H9572_002_1	7	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		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												
H9572	002	1	1	04	01	H9572_002_1	7	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												
H9572	002	1	1	04	01	H9572_002_1	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											79.00	50		50				57.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	002	1	1	04	01	H9572_002_1	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	002	2	1	04	01	H9572_002_2	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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												
H9572	002	2	1	04	01	H9572_002_2	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	002	2	1	04	01	H9572_002_2	7	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		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												
H9572	002	2	1	04	01	H9572_002_2	7	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												
H9572	002	2	1	04	01	H9572_002_2	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											79.00	50		50				57.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	002	2	1	04	01	H9572_002_2	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	002	3	1	04	01	H9572_002_3	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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												
H9572	002	3	1	04	01	H9572_002_3	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	002	3	1	04	01	H9572_002_3	7	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		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												
H9572	002	3	1	04	01	H9572_002_3	7	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												
H9572	002	3	1	04	01	H9572_002_3	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											79.00	50		50				57.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	002	3	1	04	01	H9572_002_3	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	002	4	1	04	01	H9572_002_4	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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												
H9572	002	4	1	04	01	H9572_002_4	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	002	4	1	04	01	H9572_002_4	7	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		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												
H9572	002	4	1	04	01	H9572_002_4	7	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												
H9572	002	4	1	04	01	H9572_002_4	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											79.00	50		50				57.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	002	4	1	04	01	H9572_002_4	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	002	6	1	04	01	H9572_002_6	7	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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												
H9572	002	6	1	04	01	H9572_002_6	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	002	6	1	04	01	H9572_002_6	7	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		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												
H9572	002	6	1	04	01	H9572_002_6	7	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												
H9572	002	6	1	04	01	H9572_002_6	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											79.00	50		50				57.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	002	6	1	04	01	H9572_002_6	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	7	Preferred Generic	4	01	1	2	1	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												
H9572	003	1	1	04	01	H9572_003_1	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	003	1	1	04	01	H9572_003_1	7	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												
H9572	003	1	1	04	01	H9572_003_1	7	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												
H9572	003	1	1	04	01	H9572_003_1	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											62.00	45		45				64.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	7	Preferred Generic	4	01	1	2	1	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												
H9572	003	2	1	04	01	H9572_003_2	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	003	2	1	04	01	H9572_003_2	7	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												
H9572	003	2	1	04	01	H9572_003_2	7	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												
H9572	003	2	1	04	01	H9572_003_2	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											62.00	45		45				64.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	7	Preferred Generic	4	01	1	2	1	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												
H9572	003	3	1	04	01	H9572_003_3	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	003	3	1	04	01	H9572_003_3	7	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												
H9572	003	3	1	04	01	H9572_003_3	7	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												
H9572	003	3	1	04	01	H9572_003_3	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											62.00	45		45				64.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	7	Preferred Generic	4	01	1	2	1	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												
H9572	003	4	1	04	01	H9572_003_4	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	003	4	1	04	01	H9572_003_4	7	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												
H9572	003	4	1	04	01	H9572_003_4	7	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												
H9572	003	4	1	04	01	H9572_003_4	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											62.00	45		45				64.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	7	Preferred Generic	4	01	1	2	1	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												
H9572	003	6	1	04	01	H9572_003_6	7	Preferred Generic	4	01	1	2	1	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										2		
H9572	003	6	1	04	01	H9572_003_6	7	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												
H9572	003	6	1	04	01	H9572_003_6	7	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												
H9572	003	6	1	04	01	H9572_003_6	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											62.00	45		45				64.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	1	1	04	01	H9572_004_1	8	Preferred Generic	4	01	1	2	1	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												
H9572	004	1	1	04	01	H9572_004_1	8	Preferred Generic	4	01	1	2	1	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										2		
H9572	004	1	1	04	01	H9572_004_1	8	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												
H9572	004	1	1	04	01	H9572_004_1	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	1	1	04	01	H9572_004_1	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											64.00	50		50				69.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	1	1	04	01	H9572_004_1	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	2	1	04	01	H9572_004_2	8	Preferred Generic	4	01	1	2	1	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												
H9572	004	2	1	04	01	H9572_004_2	8	Preferred Generic	4	01	1	2	1	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										2		
H9572	004	2	1	04	01	H9572_004_2	8	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												
H9572	004	2	1	04	01	H9572_004_2	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	2	1	04	01	H9572_004_2	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											64.00	50		50				69.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	2	1	04	01	H9572_004_2	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	3	1	04	01	H9572_004_3	8	Preferred Generic	4	01	1	2	1	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												
H9572	004	3	1	04	01	H9572_004_3	8	Preferred Generic	4	01	1	2	1	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										2		
H9572	004	3	1	04	01	H9572_004_3	8	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												
H9572	004	3	1	04	01	H9572_004_3	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	3	1	04	01	H9572_004_3	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											64.00	50		50				69.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	3	1	04	01	H9572_004_3	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	4	1	04	01	H9572_004_4	8	Preferred Generic	4	01	1	2	1	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												
H9572	004	4	1	04	01	H9572_004_4	8	Preferred Generic	4	01	1	2	1	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										2		
H9572	004	4	1	04	01	H9572_004_4	8	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												
H9572	004	4	1	04	01	H9572_004_4	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	4	1	04	01	H9572_004_4	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											64.00	50		50				69.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	4	1	04	01	H9572_004_4	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	6	1	04	01	H9572_004_6	8	Preferred Generic	4	01	1	2	1	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												
H9572	004	6	1	04	01	H9572_004_6	8	Preferred Generic	4	01	1	2	1	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										2		
H9572	004	6	1	04	01	H9572_004_6	8	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												
H9572	004	6	1	04	01	H9572_004_6	8	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	6	1	04	01	H9572_004_6	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											64.00	50		50				69.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	004	6	1	04	01	H9572_004_6	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9576	001	0	1	48	05	H9576_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			
H9576	001	0	1	48	05	H9576_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			
H9576	001	0	1	48	05	H9576_001_0	2	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	8	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	5.00					0.00	0.00	0.00											5.00	10.00	5.00				0.00	0.00	0.00				0.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9589	003	0	1	04	01	H9589_003_0	8	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	42.50					12.00	24.00	30.00											17.00	34.00	42.50				12.00	24.00	30.00				12.00				12.00			0.57	0.40		0.57	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9589	003	0	1	04	01	H9589_003_0	8	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9589	003	0	1	04	01	H9589_003_0	8	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	250.00					95.00	190.00	237.50											100.00	200.00	250.00				95.00	190.00	237.50				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9589	003	0	1	04	01	H9589_003_0	8	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											836.64	28	28	28				836.64	28	28	28										28	28	28				28	28	28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9614	001	0	1	04	01	H9614_001_0	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9614	001	0	1	04	01	H9614_001_0	6	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	15.00																			5.00	10.00	15.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9614	001	0	1	04	01	H9614_001_0	6	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9614	001	0	1	04	01	H9614_001_0	6	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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9614	001	0	1	04	01	H9614_001_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				935.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9614	001	0	1	04	01	H9614_001_0	6	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	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, Select Care Drugs												
H9614	001	0	1	04	01	H9614_001_0	6	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	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, Select Care Drugs										1		
H9615	007	0	1	04	01	H9615_007_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_0	6	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	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	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	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				98.08	26		26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_0	6	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	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	008	0	1	04	01	H9615_008_0	6	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	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	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		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	6	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	6	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	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				97.92	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	009	0	1	04	01	H9615_009_0	6	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	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	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	Preferred Brand	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	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	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	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	012	0	1	04	01	H9615_012_0	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	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	012	0	1	04	01	H9615_012_0	7	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	012	0	1	04	01	H9615_012_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				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	7	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	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	014	0	1	04	01	H9615_014_0	6	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	014	0	1	04	01	H9615_014_0	6	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	014	0	1	04	01	H9615_014_0	6	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	014	0	1	04	01	H9615_014_0	6	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	015	0	1	04	01	H9615_015_0	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	015	0	1	04	01	H9615_015_0	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	015	0	1	04	01	H9615_015_0	7	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	015	0	1	04	01	H9615_015_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	015	0	1	04	01	H9615_015_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				764.19	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	016	0	1	04	01	H9615_016_0	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	016	0	1	04	01	H9615_016_0	7	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	016	0	1	04	01	H9615_016_0	7	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	42.00		126.00																			42.00		84.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	016	0	1	04	01	H9615_016_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	016	0	1	04	01	H9615_016_0	7	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	017	0	1	04	01	H9615_017_0	6	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	017	0	1	04	01	H9615_017_0	6	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	017	0	1	04	01	H9615_017_0	6	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	017	0	1	04	01	H9615_017_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	017	0	1	04	01	H9615_017_0	6	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												
H9630	001	0	1	01	01	H9630_001_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	001	0	1	01	01	H9630_001_0	5	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	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	001	0	1	01	01	H9630_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	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, Select Care Drugs												
H9630	001	0	1	01	01	H9630_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	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, Select Care Drugs												
H9630	001	0	1	01	01	H9630_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	001	0	1	01	01	H9630_001_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	5	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	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	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												
H9630	002	0	1	01	01	H9630_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	5	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	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	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, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	004	0	1	01	01	H9630_004_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	004	0	1	01	01	H9630_004_0	5	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	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	004	0	1	01	01	H9630_004_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H9630	004	0	1	01	01	H9630_004_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	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, Select Care Drugs												
H9630	004	0	1	01	01	H9630_004_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	004	0	1	01	01	H9630_004_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				85.13	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		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	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	006	0	1	01	01	H9630_006_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	006	0	1	01	01	H9630_006_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H9630	006	0	1	01	01	H9630_006_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				75.54	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	006	0	1	01	01	H9630_006_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	006	0	1	01	01	H9630_006_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				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	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	008	0	1	01	01	H9630_008_0	5	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	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	008	0	1	01	01	H9630_008_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H9630	008	0	1	01	01	H9630_008_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									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, Select Care Drugs												
H9630	008	0	1	01	01	H9630_008_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	008	0	1	01	01	H9630_008_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	010	0	1	01	01	H9630_010_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	010	0	1	01	01	H9630_010_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	12.00	24.00	36.00																									12.00	24.00	36.00				12.00	24.00	0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	010	0	1	01	01	H9630_010_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H9630	010	0	1	01	01	H9630_010_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.04	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	010	0	1	01	01	H9630_010_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	010	0	1	01	01	H9630_010_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	011	0	1	01	01	H9630_011_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	011	0	1	01	01	H9630_011_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	12.00	24.00	36.00																									12.00	24.00	36.00				12.00	24.00	0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	011	0	1	01	01	H9630_011_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	011	0	1	01	01	H9630_011_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.04	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	011	0	1	01	01	H9630_011_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	011	0	1	01	01	H9630_011_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	001	0	1	01	01	H9686_001_0	5	Preferred Generic	4	11	1	2	1	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	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	5	Preferred Generic	4	11	1	2	1	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9686	001	0	1	01	01	H9686_001_0	5	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	001	0	1	01	01	H9686_001_0	5	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	001	0	1	01	01	H9686_001_0	5	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	279.00																	93.00			93.00		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	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				935.00	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	5	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		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	5	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9686	003	0	1	01	01	H9686_003_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	003	0	1	01	01	H9686_003_0	7	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	003	0	1	01	01	H9686_003_0	7	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	003	0	1	01	01	H9686_003_0	7	Non-Preferred Drug	4	11	3	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	93.00	186.00	279.00																			93.00	186.00	279.00																	93.00			93.00		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	7	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				944.00	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	7	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			5.00		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	7	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			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9686	004	0	1	01	01	H9686_004_0	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	004	0	1	01	01	H9686_004_0	6	Generic	4	01	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	004	0	1	01	01	H9686_004_0	6	Preferred Brand	4	11	3	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	004	0	1	01	01	H9686_004_0	6	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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	004	0	1	01	01	H9686_004_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				868.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	004	0	1	01	01	H9686_004_0	6	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	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, Select Care Drugs												
H9686	004	0	1	01	01	H9686_004_0	6	Select Care Drugs	4	01	1	2	6	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	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, Select Care Drugs										1		
H9686	005	0	1	01	01	H9686_005_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	005	0	1	01	01	H9686_005_0	5	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																			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												
H9686	005	0	1	01	01	H9686_005_0	5	Preferred Brand	4	11	3	1	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31				90.00	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	005	0	1	01	01	H9686_005_0	5	Non-Preferred Drug	4	11	3	1	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31				89.00	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	005	0	1	01	01	H9686_005_0	5	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				678.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	005	0	1	01	01	H9686_005_0	5	Select Care Drugs	4	01	1	2	6	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	5.00	10.00	0.00																			5.00	10.00	0.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	1	1	01	01	H9699_004_1	5	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	004	1	1	01	01	H9699_004_1	5	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		26.00																13.00				13.00		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	5	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	40.00		80.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	1	1	01	01	H9699_004_1	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				95.21	45		45																		45		45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	1	1	01	01	H9699_004_1	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	1	1	01	01	H9699_004_1	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9699	004	2	1	01	01	H9699_004_2	5	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	004	2	1	01	01	H9699_004_2	5	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		26.00																13.00				13.00		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	5	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	40.00		80.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	2	1	01	01	H9699_004_2	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				95.21	45		45																		45		45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	2	1	01	01	H9699_004_2	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	2	1	01	01	H9699_004_2	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9699	004	3	1	01	01	H9699_004_3	5	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	004	3	1	01	01	H9699_004_3	5	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		26.00																13.00				13.00		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	5	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	40.00		80.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	3	1	01	01	H9699_004_3	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				95.21	45		45																		45		45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	3	1	01	01	H9699_004_3	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	3	1	01	01	H9699_004_3	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9699	006	0	1	01	01	H9699_006_0	5	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	5	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	5	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	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				98.51	45		45																		45		45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	006	0	1	01	01	H9699_006_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	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	5	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	5	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	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	001	0	1	01	01	H9706_001_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H9706	001	0	1	01	01	H9706_001_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	001	0	1	01	01	H9706_001_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H9706	001	0	1	01	01	H9706_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	001	0	1	01	01	H9706_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	003	0	1	01	01	H9706_003_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	003	0	1	01	01	H9706_003_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H9706	003	0	1	01	01	H9706_003_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	003	0	1	01	01	H9706_003_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H9706	003	0	1	01	01	H9706_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	003	0	1	01	01	H9706_003_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	005	0	1	01	01	H9706_005_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	005	0	1	01	01	H9706_005_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		100	1	2				30		100	30		31								10.00		30.00					0.00		0.00											10.00		20.00				0.00		0.00				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		
H9706	005	0	1	01	01	H9706_005_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	005	0	1	01	01	H9706_005_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		94.00				47.00		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												
H9706	005	0	1	01	01	H9706_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	005	0	1	01	01	H9706_005_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9712	001	0	1	48	05	H9712_001_0	4	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs	3	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				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			
H9725	001	0	1	01	01	H9725_001_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	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												
H9725	001	0	1	01	01	H9725_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	4	Non-Preferred Drug	4	11	1	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											935.68	33						744.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	006	0	1	01	01	H9725_006_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4	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					4.00	8.00	8.00											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												
H9725	006	0	1	01	01	H9725_006_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	006	0	1	01	01	H9725_006_0	4	Non-Preferred Drug	4	11	1	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1013.62	33						698.09	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	007	0	1	01	01	H9725_007_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	007	0	1	01	01	H9725_007_0	4	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					5.00	10.00	10.00											15.00	30.00	45.00				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												
H9725	007	0	1	01	01	H9725_007_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	007	0	1	01	01	H9725_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	007	0	1	01	01	H9725_007_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											935.68	33						744.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	008	0	1	01	01	H9725_008_0	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H9725	008	0	1	01	01	H9725_008_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					10.00	20.00	20.00											20.00	40.00	40.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	008	0	1	01	01	H9725_008_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	008	0	1	01	01	H9725_008_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											88.22	50	50	50				69.57	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	008	0	1	01	01	H9725_008_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											913.15	33						761.08	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	003	0	1	01	01	H9730_003_0	5	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	15.00				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												
H9730	003	0	1	01	01	H9730_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	34.00	68.00	102.00																									34.00	68.00	102.00				34.00	68.00	68.00				34.00				34.00		1.13				1.13	1.13	1.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	003	0	1	01	01	H9730_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.10	45	45	45																								45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	003	0	1	01	01	H9730_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	003	0	1	01	01	H9730_003_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	004	0	1	01	01	H9730_004_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	004	0	1	01	01	H9730_004_0	6	Generic	4	11	1	2	2	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	4.00	0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	004	0	1	01	01	H9730_004_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	31.00	62.00	93.00																									31.00	62.00	93.00				31.00	62.00	62.00				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	004	0	1	01	01	H9730_004_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.43	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	004	0	1	01	01	H9730_004_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	004	0	1	01	01	H9730_004_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	005	0	1	02	01	H9730_005_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	005	0	1	02	01	H9730_005_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9730	005	0	1	02	01	H9730_005_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											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, Select Care Drugs												
H9730	005	0	1	02	01	H9730_005_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H9730	005	0	1	02	01	H9730_005_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.20	49	49	49				95.15	47	47	47										49	49	49				47	47	47			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	005	0	1	02	01	H9730_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	005	0	1	02	01	H9730_005_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	005	0	1	02	01	H9730_005_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H9730	007	0	1	01	01	H9730_007_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	007	0	1	01	01	H9730_007_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H9730	007	0	1	01	01	H9730_007_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H9730	007	0	1	01	01	H9730_007_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.19	50	50	50				95.23	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	007	0	1	01	01	H9730_007_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	007	0	1	01	01	H9730_007_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	007	0	1	01	01	H9730_007_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H9730	009	0	1	01	01	H9730_009_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	009	0	1	01	01	H9730_009_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9730	009	0	1	01	01	H9730_009_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H9730	009	0	1	01	01	H9730_009_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	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												
H9730	009	0	1	01	01	H9730_009_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.95	48	48	48				93.86	46	46	46										48	48	48				46	46	46			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	009	0	1	01	01	H9730_009_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	009	0	1	01	01	H9730_009_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	009	0	1	01	01	H9730_009_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H9730	010	0	1	01	01	H9730_010_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	010	0	1	01	01	H9730_010_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	010	0	1	01	01	H9730_010_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H9730	010	0	1	01	01	H9730_010_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.91	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	010	0	1	01	01	H9730_010_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	010	0	1	01	01	H9730_010_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	001	0	1	04	01	H9761_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	001	0	1	04	01	H9761_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	001	0	1	04	01	H9761_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9761	001	0	1	04	01	H9761_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.83	45	45	45				94.44	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	001	0	1	04	01	H9761_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	001	0	1	04	01	H9761_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	002	0	1	04	01	H9761_002_0	5	Preferred Generic	4	11	3	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			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	002	0	1	04	01	H9761_002_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	002	0	1	04	01	H9761_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9761	002	0	1	04	01	H9761_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											93.75	50	50	50				90.00	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	002	0	1	04	01	H9761_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	002	0	1	04	01	H9761_002_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	002	0	1	04	01	H9761_002_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H9761	003	0	1	04	01	H9761_003_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	003	0	1	04	01	H9761_003_0	6	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	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	003	0	1	04	01	H9761_003_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H9761	003	0	1	04	01	H9761_003_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.10	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	003	0	1	04	01	H9761_003_0	6	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	003	0	1	04	01	H9761_003_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	004	0	1	04	01	H9761_004_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	004	0	1	04	01	H9761_004_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	004	0	1	04	01	H9761_004_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	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, Select Care Drugs												
H9761	004	0	1	04	01	H9761_004_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.83	45	45	45				94.43	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	004	0	1	04	01	H9761_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	004	0	1	04	01	H9761_004_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9763	001	0	1	01	01	H9763_001_0	4	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												
H9763	001	0	1	01	01	H9763_001_0	4	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9763	001	0	1	01	01	H9763_001_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	0.00																					0.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9763	001	0	1	01	01	H9763_001_0	4	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	0.00																					0.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H9763	001	0	1	01	01	H9763_001_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9763	001	0	1	01	01	H9763_001_0	4	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												
H9763	001	0	1	01	01	H9763_001_0	4	Specialty Tier	4	11	1	1	5	1	111		01	110		1	30	60	90				2	2	30		90				30		31					33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9763	002	0	1	02	01	H9763_002_0	5	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												
H9763	002	0	1	02	01	H9763_002_0	5	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9763	002	0	1	02	01	H9763_002_0	5	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	0.00																					0.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9763	002	0	1	02	01	H9763_002_0	5	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	0.00																					0.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H9763	002	0	1	02	01	H9763_002_0	5	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9763	002	0	1	02	01	H9763_002_0	5	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												
H9763	002	0	1	02	01	H9763_002_0	5	Specialty Tier	4	11	1	1	5	1	111		01	110		1	30	60	90				2	2	30		90				30		31					33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	11	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	11	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	11	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	11	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	11	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												
H9808	004	0	1	04	01	H9808_004_0	11	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1451.87	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	11	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	11	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	11	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	11	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	11	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	11	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1371.54	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	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9811	001	0	1	01	01	H9811_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					32.00	64.00	96.00											42.00	84.00	126.00				32.00	64.00	64.00				42.00				42.00			1.4	1.07		1.4	1.07	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	Non-Preferred Drug	4	11	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	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, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H9811	006	0	1	01	01	H9811_006_0	6	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	006	0	1	01	01	H9811_006_0	6	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																									14.00	28.00	42.00				14.00	28.00	0.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	006	0	1	01	01	H9811_006_0	6	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H9811	006	0	1	01	01	H9811_006_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				97.59	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	006	0	1	01	01	H9811_006_0	6	Specialty Tier	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												
H9811	006	0	1	01	01	H9811_006_0	6	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	008	0	1	01	01	H9811_008_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	008	0	1	01	01	H9811_008_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	008	0	1	01	01	H9811_008_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H9811	008	0	1	01	01	H9811_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H9811	008	0	1	01	01	H9811_008_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	008	0	1	01	01	H9811_008_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	009	0	1	01	01	H9811_009_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	009	0	1	01	01	H9811_009_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	009	0	1	01	01	H9811_009_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H9811	009	0	1	01	01	H9811_009_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.52	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	009	0	1	01	01	H9811_009_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	009	0	1	01	01	H9811_009_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9827	001	0	1	01	01	H9827_001_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	001	0	1	01	01	H9827_001_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9827	001	0	1	01	01	H9827_001_0	5	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												
H9827	001	0	1	01	01	H9827_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	001	0	1	01	01	H9827_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	001	0	1	01	01	H9827_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	002	0	1	01	01	H9827_002_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	002	0	1	01	01	H9827_002_0	5	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9827	002	0	1	01	01	H9827_002_0	5	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												
H9827	002	0	1	01	01	H9827_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	002	0	1	01	01	H9827_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	002	0	1	01	01	H9827_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9828	001	0	1	01	01	H9828_001_0	7	Preferred Generic	4	01	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 Brand, Specialty Tier, Select Care Drugs												
H9828	001	0	1	01	01	H9828_001_0	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	001	0	1	01	01	H9828_001_0	7	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	001	0	1	01	01	H9828_001_0	7	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	1			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, Select Care Drugs												
H9828	001	0	1	01	01	H9828_001_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	001	0	1	01	01	H9828_001_0	7	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	001	0	1	01	01	H9828_001_0	7	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9828	002	0	1	01	01	H9828_002_0	7	Preferred Generic	4	01	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 Brand, Specialty Tier, Select Care Drugs												
H9828	002	0	1	01	01	H9828_002_0	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					24.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	002	0	1	01	01	H9828_002_0	7	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					120.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	002	0	1	01	01	H9828_002_0	7	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	1			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, Select Care Drugs												
H9828	002	0	1	01	01	H9828_002_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	002	0	1	01	01	H9828_002_0	7	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	002	0	1	01	01	H9828_002_0	7	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9828	003	0	1	01	01	H9828_003_0	7	Preferred Generic	4	01	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 Brand, Specialty Tier, Select Care Drugs												
H9828	003	0	1	01	01	H9828_003_0	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	003	0	1	01	01	H9828_003_0	7	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	003	0	1	01	01	H9828_003_0	7	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	1			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, Select Care Drugs												
H9828	003	0	1	01	01	H9828_003_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	003	0	1	01	01	H9828_003_0	7	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	003	0	1	01	01	H9828_003_0	7	Select Care Drugs	4	01	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9834	001	0	1	01	01	H9834_001_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	001	0	1	01	01	H9834_001_0	4	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	001	0	1	01	01	H9834_001_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	001	0	1	01	01	H9834_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				64.61	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	001	0	1	01	01	H9834_001_0	4	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, Vaccines												
H9834	001	0	1	01	01	H9834_001_0	4	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 Drug, Specialty Tier, Vaccines												
H9834	001	0	1	01	01	H9834_001_0	4	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 Drug, Specialty Tier, Vaccines										1		
H9834	003	0	1	01	01	H9834_003_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	003	0	1	01	01	H9834_003_0	4	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	003	0	1	01	01	H9834_003_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	003	0	1	01	01	H9834_003_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				81.34	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	003	0	1	01	01	H9834_003_0	4	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, Vaccines												
H9834	003	0	1	01	01	H9834_003_0	4	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 Drug, Specialty Tier, Vaccines												
H9834	003	0	1	01	01	H9834_003_0	4	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 Drug, Specialty Tier, Vaccines										1		
H9834	006	0	1	01	01	H9834_006_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	006	0	1	01	01	H9834_006_0	4	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	006	0	1	01	01	H9834_006_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	006	0	1	01	01	H9834_006_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				90.75	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	006	0	1	01	01	H9834_006_0	4	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, Vaccines												
H9834	006	0	1	01	01	H9834_006_0	4	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 Drug, Specialty Tier, Vaccines												
H9834	006	0	1	01	01	H9834_006_0	4	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 Drug, Specialty Tier, Vaccines										1		
H9861	001	0	1	01	01	H9861_001_0	8	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		18.00					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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1654.00	30						1654.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	002	0	1	01	01	H9861_002_0	8	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		18.00					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	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	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	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	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1654.00	30						1654.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9869	001	0	1	48	05	H9869_001_0	1	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	1	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	1	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			
H9876	001	0	1	04	01	H9876_001_0	10	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9876	001	0	1	04	01	H9876_001_0	10	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9876	001	0	1	04	01	H9876_001_0	10	Preferred Brand	4	10	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9876	001	0	1	04	01	H9876_001_0	10	Non-Preferred Brand	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	250.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9876	001	0	1	04	01	H9876_001_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9876	002	0	1	04	01	H9876_002_0	10	Preferred Generic	3	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	6.50	13.00	19.50																			6.50	13.00	19.50																6.50				6.50		0.21			0.21			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9876	002	0	1	04	01	H9876_002_0	10	Generic	3	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				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												
H9876	002	0	1	04	01	H9876_002_0	10	Preferred Brand	3	10	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			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												
H9876	002	0	1	04	01	H9876_002_0	10	Non-Preferred Brand	3	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 Brand, Specialty Tier												
H9876	002	0	1	04	01	H9876_002_0	10	Specialty Tier	3	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9884	001	0	1	04	01	H9884_001_0	10	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												
H9884	001	0	1	04	01	H9884_001_0	10	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										2	2	
H9884	001	0	1	04	01	H9884_001_0	10	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												
H9884	001	0	1	04	01	H9884_001_0	10	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										2	2	3
H9884	001	0	1	04	01	H9884_001_0	10	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												
H9884	001	0	1	04	01	H9884_001_0	10	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												
H9884	001	0	1	04	01	H9884_001_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				915.87	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	003	0	1	04	01	H9884_003_0	10	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												
H9884	003	0	1	04	01	H9884_003_0	10	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										2	2	
H9884	003	0	1	04	01	H9884_003_0	10	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												
H9884	003	0	1	04	01	H9884_003_0	10	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										2	2	3
H9884	003	0	1	04	01	H9884_003_0	10	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												
H9884	003	0	1	04	01	H9884_003_0	10	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												
H9884	003	0	1	04	01	H9884_003_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				917.67	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	004	0	1	04	01	H9884_004_0	10	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												
H9884	004	0	1	04	01	H9884_004_0	10	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										2	2	
H9884	004	0	1	04	01	H9884_004_0	10	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												
H9884	004	0	1	04	01	H9884_004_0	10	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										2	2	3
H9884	004	0	1	04	01	H9884_004_0	10	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												
H9884	004	0	1	04	01	H9884_004_0	10	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												
H9884	004	0	1	04	01	H9884_004_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				917.25	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	005	0	1	04	01	H9884_005_0	10	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												
H9884	005	0	1	04	01	H9884_005_0	10	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										2	2	
H9884	005	0	1	04	01	H9884_005_0	10	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												
H9884	005	0	1	04	01	H9884_005_0	10	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										2	2	3
H9884	005	0	1	04	01	H9884_005_0	10	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												
H9884	005	0	1	04	01	H9884_005_0	10	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												
H9884	005	0	1	04	01	H9884_005_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				918.80	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	006	0	1	04	01	H9884_006_0	10	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												
H9884	006	0	1	04	01	H9884_006_0	10	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										2	2	
H9884	006	0	1	04	01	H9884_006_0	10	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												
H9884	006	0	1	04	01	H9884_006_0	10	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										2	2	3
H9884	006	0	1	04	01	H9884_006_0	10	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												
H9884	006	0	1	04	01	H9884_006_0	10	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												
H9884	006	0	1	04	01	H9884_006_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				914.96	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	007	0	1	04	01	H9884_007_0	10	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												
H9884	007	0	1	04	01	H9884_007_0	10	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										2	2	
H9884	007	0	1	04	01	H9884_007_0	10	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												
H9884	007	0	1	04	01	H9884_007_0	10	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										2	2	3
H9884	007	0	1	04	01	H9884_007_0	10	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												
H9884	007	0	1	04	01	H9884_007_0	10	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												
H9884	007	0	1	04	01	H9884_007_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				920.54	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9900	001	0	1	01	01	H9900_001_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	001	0	1	01	01	H9900_001_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H9900	001	0	1	01	01	H9900_001_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9900	001	0	1	01	01	H9900_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H9900	001	0	1	01	01	H9900_001_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	001	0	1	01	01	H9900_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	002	0	1	01	01	H9900_002_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	002	0	1	01	01	H9900_002_0	5	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	0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	002	0	1	01	01	H9900_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	44.00	88.00	132.00																									44.00	88.00	132.00				44.00	88.00	88.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	002	0	1	01	01	H9900_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.51	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	002	0	1	01	01	H9900_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	002	0	1	01	01	H9900_002_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	003	0	1	01	01	H9900_003_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	003	0	1	01	01	H9900_003_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	003	0	1	01	01	H9900_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	42.00	84.00	126.00																									42.00	84.00	126.00				42.00	84.00	84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	003	0	1	01	01	H9900_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.51	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	003	0	1	01	01	H9900_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	003	0	1	01	01	H9900_003_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	004	0	1	01	01	H9900_004_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	004	0	1	01	01	H9900_004_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9900	004	0	1	01	01	H9900_004_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H9900	004	0	1	01	01	H9900_004_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9900	004	0	1	01	01	H9900_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H9900	004	0	1	01	01	H9900_004_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	004	0	1	01	01	H9900_004_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	004	0	1	01	01	H9900_004_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H9900	005	0	1	01	01	H9900_005_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	005	0	1	01	01	H9900_005_0	5	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9900	005	0	1	01	01	H9900_005_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	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, Select Care Drugs												
H9900	005	0	1	01	01	H9900_005_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H9900	005	0	1	01	01	H9900_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H9900	005	0	1	01	01	H9900_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	005	0	1	01	01	H9900_005_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	005	0	1	01	01	H9900_005_0	5	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H9900	006	0	1	01	01	H9900_006_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	006	0	1	01	01	H9900_006_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	006	0	1	01	01	H9900_006_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H9900	006	0	1	01	01	H9900_006_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.85	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	006	0	1	01	01	H9900_006_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	006	0	1	01	01	H9900_006_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	007	0	1	01	01	H9900_007_0	5	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	007	0	1	01	01	H9900_007_0	5	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	007	0	1	01	01	H9900_007_0	5	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H9900	007	0	1	01	01	H9900_007_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				99.85	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	007	0	1	01	01	H9900_007_0	5	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	007	0	1	01	01	H9900_007_0	5	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9904	001	0	1	04	01	H9904_001_0	13	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	1	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												
H9904	001	0	1	04	01	H9904_001_0	13	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	1	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												
H9904	001	0	1	04	01	H9904_001_0	13	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	1	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												
H9904	001	0	1	04	01	H9904_001_0	13	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	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9904	001	0	1	04	01	H9904_001_0	13	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				1000.00	27	27	27																		27	27	27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9917	001	0	1	01	01	H9917_001_0	6	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	6.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	001	0	1	01	01	H9917_001_0	6	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			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												
H9917	001	0	1	01	01	H9917_001_0	6	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												
H9917	001	0	1	01	01	H9917_001_0	6	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												
H9917	001	0	1	01	01	H9917_001_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				797.12	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	002	0	1	01	01	H9917_002_0	6	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	6.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	002	0	1	01	01	H9917_002_0	6	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			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												
H9917	002	0	1	01	01	H9917_002_0	6	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												
H9917	002	0	1	01	01	H9917_002_0	6	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												
H9917	002	0	1	01	01	H9917_002_0	6	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				797.12	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9955	001	0	1	01	01	H9955_001_0	7	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	7	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	7	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	7	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.91	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	001	0	1	01	01	H9955_001_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				664.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	002	0	1	01	01	H9955_002_0	5	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9955	002	0	1	01	01	H9955_002_0	5	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9955	002	0	1	01	01	H9955_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9955	002	0	1	01	01	H9955_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9955	002	0	1	01	01	H9955_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				973.87	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9955	002	0	1	01	01	H9955_002_0	5	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	001	0	1	04	01	H9976_001_0	4	Preferred Generic	4	11	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	001	0	1	04	01	H9976_001_0	4	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				15.00	30.00	0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	001	0	1	04	01	H9976_001_0	4	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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, Select Care Drugs												
H9976	001	0	1	04	01	H9976_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.10	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	001	0	1	04	01	H9976_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	001	0	1	04	01	H9976_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	002	0	1	04	01	H9976_002_0	5	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	002	0	1	04	01	H9976_002_0	5	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H9976	002	0	1	04	01	H9976_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9976	002	0	1	04	01	H9976_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.83	45	45	45				94.44	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	002	0	1	04	01	H9976_002_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	002	0	1	04	01	H9976_002_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	003	0	1	04	01	H9976_003_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	003	0	1	04	01	H9976_003_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H9976	003	0	1	04	01	H9976_003_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9976	003	0	1	04	01	H9976_003_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.83	45	45	45				94.44	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	003	0	1	04	01	H9976_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	003	0	1	04	01	H9976_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	004	0	1	04	01	H9976_004_0	4	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	004	0	1	04	01	H9976_004_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											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, Select Care Drugs												
H9976	004	0	1	04	01	H9976_004_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											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												
H9976	004	0	1	04	01	H9976_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	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, Select Care Drugs												
H9976	004	0	1	04	01	H9976_004_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	004	0	1	04	01	H9976_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9976	004	0	1	04	01	H9976_004_0	4	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
R0110	003	0	1	31	11	R0110_003_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					6.00		18.00											15.00		45.00				6.00		0.00				15.00				15.00			0.50	0.20		0.50	0.20	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0759	001	0	1	31	11	R0759_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0759	001	0	1	31	11	R0759_001_0	4	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		
R0759	001	0	1	31	11	R0759_001_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				233.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0802	001	0	1	31	11	R0802_001_0	7	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	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	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					10.00	20.00	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	7	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0802	001	0	1	31	11	R0802_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	237.50																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0802	001	0	1	31	11	R0802_001_0	7	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	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	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_003_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_003_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_0	3	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												
R1390	002	0	1	31	11	R1390_002_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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												
R1390	002	0	1	31	11	R1390_002_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		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	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												
R1532	002	0	1	31	11	R1532_002_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					14.00		42.00											15.00		45.00				14.00		0.00				15.00				15.00			0.50	0.47		0.50	0.47	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_002_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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												
R1532	002	0	1	31	11	R1532_002_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_002_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_002_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	001	0	1	31	11	R2604_001_0	2	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	2	Preferred Generic	4	01	1	2	1	3	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										1		
R2604	001	0	1	31	11	R2604_001_0	2	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	2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	001	0	1	31	11	R2604_001_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	001	0	1	31	11	R2604_001_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				320.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	003	0	1	31	11	R2604_003_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		8.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	003	0	1	31	11	R2604_003_0	3	Preferred Generic	4	01	1	2	1	3	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										1		
R2604	003	0	1	31	11	R2604_003_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		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	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		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	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				235.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1340.24	28						1340.24	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	5	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	5	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
R3392	002	0	1	31	11	R3392_002_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	002	0	1	31	11	R3392_002_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	002	0	1	31	11	R3392_002_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	002	0	1	31	11	R3392_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	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	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	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										1		
R3444	009	0	1	31	11	R3444_009_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	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												
R3444	009	0	1	31	11	R3444_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				271.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	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	2	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	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										1		
R3444	012	0	1	31	11	R3444_012_0	2	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2	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												
R3444	012	0	1	31	11	R3444_012_0	2	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												
R3444	012	0	1	31	11	R3444_012_0	2	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												
R3444	023	0	1	31	11	R3444_023_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	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	2	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	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										1		
R3444	023	0	1	31	11	R3444_023_0	2	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2	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												
R3444	023	0	1	31	11	R3444_023_0	2	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												
R3444	023	0	1	31	11	R3444_023_0	2	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				354.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3887	002	0	1	31	11	R3887_002_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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												
R3887	002	0	1	31	11	R3887_002_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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												
R3887	002	0	1	31	11	R3887_002_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3887	002	0	1	31	11	R3887_002_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3887	002	0	1	31	11	R3887_002_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_003_0	3	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_003_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	3	Non-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	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												
R4182	004	0	1	31	11	R4182_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					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	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	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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	Non-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	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	10	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												
R4487	001	0	1	31	11	R4487_001_0	10	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R4487	001	0	1	31	11	R4487_001_0	10	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	10	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											78.76	47	47	47				77.08	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	10	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	10	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	10	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	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					12.00		36.00											15.00		45.00				12.00		0.00				15.00				15.00			0.50	0.40		0.50	0.40	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4845	002	0	1	31	11	R4845_002_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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												
R4845	002	0	1	31	11	R4845_002_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4845	002	0	1	31	11	R4845_002_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4845	002	0	1	31	11	R4845_002_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R5329	001	0	1	31	11	R5329_001_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R5329	001	0	1	31	11	R5329_001_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				211.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				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												
R5342	001	0	1	31	11	R5342_001_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R5342	001	0	1	31	11	R5342_001_0	3	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	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	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	3	Specialty Tier	4	11	1	1	5	1	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												
R5342	005	0	1	31	11	R5342_005_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R5342	005	0	1	31	11	R5342_005_0	3	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												
R5342	005	0	1	31	11	R5342_005_0	3	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
R5342	005	0	1	31	11	R5342_005_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				237.00	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	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												
R5342	006	0	1	31	11	R5342_006_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R5342	006	0	1	31	11	R5342_006_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R5342	006	0	1	31	11	R5342_006_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				263.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_002_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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												
R5361	002	0	1	31	11	R5361_002_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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												
R5361	002	0	1	31	11	R5361_002_0	3	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_002_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_002_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_002_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					16.00		48.00											19.00		57.00				16.00		0.00				19.00				19.00			0.63	0.53		0.63	0.53	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_002_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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												
R5495	002	0	1	31	11	R5495_002_0	3	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											22.00	17		17				22.00	17		17										17		17				17		17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_002_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											18.00	20		20				18.00	20		20										20		20				20		20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_002_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	4	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_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												
R5826	005	0	1	31	11	R5826_005_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	4	Non-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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	3	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5941	014	0	1	31	11	R5941_014_0	8	Preferred Generic	4	01	1	2	1	1		111	01	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	8	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					0.00	0.00	0.00																20.00				20.00			0.67	0.50	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	8	Preferred Brand	4	11	1	2	3	1		111	01	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	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											77.30	42	42	42				75.46	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	8	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	2	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	003	0	1	31	11	R6694_003_0	2	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
R6694	003	0	1	31	11	R6694_003_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	003	0	1	31	11	R6694_003_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
R6694	003	0	1	31	11	R6694_003_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					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												
R6694	003	0	1	31	11	R6694_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					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												
R6694	003	0	1	31	11	R6694_003_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1178.12	33						332.36	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	005	0	1	31	11	R6694_005_0	3	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	005	0	1	31	11	R6694_005_0	3	Generic	3	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					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												
R6694	005	0	1	31	11	R6694_005_0	3	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	005	0	1	31	11	R6694_005_0	3	Non-Preferred Drug	3	11	1	2	4	1		111	10		111	1				30	60	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	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	005	0	1	31	11	R6694_005_0	3	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											888.09	28						228.31	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	006	0	1	31	11	R6694_006_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	006	0	1	31	11	R6694_006_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	006	0	1	31	11	R6694_006_0	3	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R6694	006	0	1	31	11	R6694_006_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	006	0	1	31	11	R6694_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	006	0	1	31	11	R6694_006_0	3	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											822.90	27						240.40	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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												
R6801	009	0	1	31	11	R6801_009_0	3	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		
R6801	009	0	1	31	11	R6801_009_0	3	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												
R6801	009	0	1	31	11	R6801_009_0	3	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
R6801	009	0	1	31	11	R6801_009_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	3	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				228.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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												
R6801	012	0	1	31	11	R6801_012_0	4	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		
R6801	012	0	1	31	11	R6801_012_0	4	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												
R6801	012	0	1	31	11	R6801_012_0	4	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
R6801	012	0	1	31	11	R6801_012_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				275.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7220	002	0	1	31	11	R7220_002_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					4.00		12.00											19.00		57.00				4.00		0.00				19.00				19.00			0.63	0.13		0.63	0.13	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7220	002	0	1	31	11	R7220_002_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				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	3	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											25.00	24		24				25.00	24		24										24		24				24		24			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7220	002	0	1	31	11	R7220_002_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	24		24				27.00	24		24										24		24				24		24			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7220	002	0	1	31	11	R7220_002_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_002_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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												
R7315	002	0	1	31	11	R7315_002_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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												
R7315	002	0	1	31	11	R7315_002_0	4	Preferred Brand	3	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	25		25				26.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_002_0	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											24.00	25		25				24.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_002_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	2	Preferred Generic	4	01	1	2	1	3	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										1		
R7444	001	0	1	31	11	R7444_001_0	2	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	2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	2	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												
S1030	001	0		29	10	S1030_001_0	1	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	1	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	1	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	1	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											99.10	50		50				99.70	45		45				45		45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	1	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	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	Generic	2	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		.26			.26			0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	1	Preferred Brand	2	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				87.80	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	1	Specialty Tier	2	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				1.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	010	0		29	10	S1030_010_0	1	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	1	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	1	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	1	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											97.70	42		42				90.10	37		37				37		37															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	010	0		29	10	S1030_010_0	1	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												
S2468	003	0		29	10	S2468_003_0	3	Preferred Generic	3	01	1	2	1	1		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	36.00					4.00	8.00	8.00							8.00																12.00				12.00			0.40	0.13				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	3	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					13.00	26.00	26.00							26.00																20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	3	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	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	003	0		29	10	S2468_003_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	01	100		1				30	60	90	2	2			90				30		31											98.30	41	41	41				91.10	38	38	38						38															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	3	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1242.12	25						1242.12	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	90	2	2			90				30		31											99.14	33	33	33				93.13	31	31	31						31															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1360.99	33						1360.99	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	2	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	2	Generic	2	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	27.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	2	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												
S2668	005	0		29	10	S2668_005_0	2	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				59.45	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	2	Specialty Tier	2	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				652.66	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	2	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					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	2	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					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	2	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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												
S2668	006	0		29	10	S2668_006_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											43.54	50	50	50				38.62	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	2	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											1216.44	33	33	33				1295.28	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											86.00	50		50				84.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	23		23				25.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	47		47				77.00	45		45										47		47				45		30			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	2	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	2	Generic	3	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
S2893	001	0		29	10	S2893_001_0	2	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					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 Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											99.41	37	37	37				77.89	37	37	37				37	37	37															37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	2	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	2	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	2	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	2	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	2	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	2	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	2	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											98.50	44	44	44				79.75	35	35	35				35	35	35															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	2	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	001	0		29	10	S3147_001_0	5	Preferred Generic	3	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												
S3147	001	0		29	10	S3147_001_0	5	Generic	3	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	11.00		33.00																					22.00																11.00				11.00		0.35						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	001	0		29	10	S3147_001_0	5	Preferred Brand	3	10	1	1	3	1	110		01	100		1	31		90				1	2			90				31		31				77.42	22		22																				22															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	001	0		29	10	S3147_001_0	5	Non-Preferred Drug	3	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				99.31	38		38																				38															38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	001	0		29	10	S3147_001_0	5	Specialty Tier	3	11	1	1	5	1	010		01			1	31														31		31				237.98	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	002	0		29	10	S3147_002_0	5	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												
S3147	002	0		29	10	S3147_002_0	5	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	6.00		18.00																					12.00																6.00				6.00		0.19						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	002	0		29	10	S3147_002_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	40.00		120.00																					80.00																40.00				40.00		1.29						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	002	0		29	10	S3147_002_0	5	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				85.10	37		37																				37															37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	002	0		29	10	S3147_002_0	5	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				244.57	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	003	0		29	10	S3147_003_0	5	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												
S3147	003	0		29	10	S3147_003_0	5	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		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												
S3147	003	0		29	10	S3147_003_0	5	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	40.00		120.00																					80.00																40.00				40.00		1.29						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	003	0		29	10	S3147_003_0	5	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				65.55	39		39																				39															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	003	0		29	10	S3147_003_0	5	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				318.92	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_0	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								4.00	8.00	12.00					1.00	2.00	3.00					1.00	2.00	3.00																4.00				4.00			0.13	0.03	0.03			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_0	4	Generic	3	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					4.00	8.00	12.00					4.00	8.00	12.00																6.00				6.00			0.20	0.13	0.13			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_0	4	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					41.00	82.00	123.00					41.00	82.00	123.00																41.00				41.00			1.37	1.37	1.37			1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											99.49	33	33	33				99.49	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_0	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	002	0		29	10	S3375_002_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	002	0		29	10	S3375_002_0	4	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	4	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	002	0		29	10	S3375_002_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											77.39	50	50	50				77.39	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	002	0		29	10	S3375_002_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	6	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					0.00	0.00	0.00											3.00	6.00	9.00				0.00	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	012	0		29	10	S4802_012_0	6	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					5.00	10.00	15.00											9.00	18.00	27.00				5.00	10.00	15.00				9.00				9.00			0.3	0.17		0.3	0.17	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	6	Preferred Brand	2	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					38.00	76.00	114.00											45.00	90.00	135.00				38.00	76.00	114.00				45.00				45.00			1.5	1.27		1.5	1.27	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	6	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.8	38	38	38				97.18	37	37	37										38	38	38				37	37	37			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	6	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	5	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					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												
S4802	013	0		29	10	S4802_013_0	5	Generic	2	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					7.00	14.00	21.00											13.00	26.00	39.00				7.00	14.00	21.00				13.00				13.00			0.43	0.23		0.43	0.23	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	5	Preferred Brand	2	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					38.00	76.00	114.00											45.00	90.00	135.00				38.00	76.00	114.00				45.00				45.00			1.5	1.27		1.5	1.27	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.98	40	40	40				97.48	39	39	39										40	40	40				39	39	39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	5	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					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												
S4802	014	0		29	10	S4802_014_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				12.00				12.00			0.4	0.23		0.4	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	4	Preferred Brand	2	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					37.00	74.00	111.00											45.00	90.00	135.00				37.00	74.00	111.00				45.00				45.00			1.5	1.23		1.5	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.18	40	40	40				96.7	39	39	39										40	40	40				39	39	39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	4	Preferred Generic	2	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	4.00	6.00				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												
S4802	020	0		29	10	S4802_020_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	12.00				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	020	0		29	10	S4802_020_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								43.00	86.00	129.00					36.00	72.00	108.00											43.00	86.00	129.00				36.00	72.00	108.00				43.00				43.00			1.43	1.2		1.43	1.2	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.09	40	40	40				95.64	39	39	39										40	40	40				39	39	39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					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												
S4802	021	0		29	10	S4802_021_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				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	021	0		29	10	S4802_021_0	4	Preferred Brand	2	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					37.00	74.00	111.00											44.00	88.00	132.00				37.00	74.00	111.00				44.00				44.00			1.47	1.23		1.47	1.23	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.39	37	37	37				95.73	36	36	36										37	37	37				36	36	36			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	5	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					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												
S4802	069	0		29	10	S4802_069_0	5	Generic	2	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	45.00				10.00	20.00	30.00				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	069	0		29	10	S4802_069_0	5	Preferred Brand	2	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					38.00	76.00	114.00											44.00	88.00	132.00				38.00	76.00	114.00				44.00				44.00			1.47	1.27		1.47	1.27	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.25	37	37	37				96.57	36	36	36										37	37	37				36	36	36			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	5	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					9.00	18.00	27.00											17.00	34.00	51.00				9.00	18.00	27.00				17.00				17.00			0.57	0.3		0.57	0.3	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	4	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					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												
S4802	070	0		29	10	S4802_070_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.31	40	40	40				94.88	39	39	39										40	40	40				39	39	39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					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												
S4802	071	0		29	10	S4802_071_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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												
S4802	071	0		29	10	S4802_071_0	4	Preferred Brand	2	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	135.00				35.00	70.00	105.00				45.00				45.00			1.5	1.17		1.5	1.17	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.13	39	39	39				96.58	38	38	38										39	39	39				38	38	38			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	18.00				0.00	0.00	0.00				6.00				6.00			0.2	0.00		0.2	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	4	Generic	2	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											16.00	32.00	48.00				8.00	16.00	24.00				16.00				16.00			0.53	0.27		0.53	0.27	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	4	Preferred Brand	2	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	135.00				35.00	70.00	105.00				45.00				45.00			1.5	1.17		1.5	1.17	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.72	34	34	34				95.82	33	33	33										34	34	34				33	33	33			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					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												
S4802	073	0		29	10	S4802_073_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					6.00	12.00	18.00											12.00	24.00	36.00				6.00	12.00	18.00				12.00				12.00			0.4	0.2		0.4	0.2	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					36.00	72.00	108.00											42.00	84.00	126.00				36.00	72.00	108.00				42.00				42.00			1.4	1.2		1.4	1.2	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.32	40	40	40				96.83	39	39	39										40	40	40				39	39	39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	4	Generic	2	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					8.00	16.00	24.00											15.00	30.00	45.00				8.00	16.00	24.00				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	074	0		29	10	S4802_074_0	4	Preferred Brand	2	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					38.00	76.00	114.00											44.00	88.00	132.00				38.00	76.00	114.00				44.00				44.00			1.47	1.27		1.47	1.27	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.63	38	38	38				96.04	37	37	37										38	38	38				37	37	37			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	4	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					0.00	0.00	0.00											3.00	6.00	9.00				0.00	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	075	0		29	10	S4802_075_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					5.00	10.00	15.00											12.00	24.00	36.00				5.00	10.00	15.00				12.00				12.00			0.4	0.17		0.4	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	4	Preferred Brand	2	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					34.00	68.00	102.00											45.00	90.00	135.00				34.00	68.00	102.00				45.00				45.00			1.5	1.13		1.5	1.13	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.83	38	38	38				97.2	37	37	37										38	38	38				37	37	37			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	4	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					0.00	0.00	0.00											3.00	6.00	9.00				0.00	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	076	0		29	10	S4802_076_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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												
S4802	076	0		29	10	S4802_076_0	4	Preferred Brand	2	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					35.00	70.00	105.00											46.00	92.00	138.00				35.00	70.00	105.00				46.00				46.00			1.53	1.17		1.53	1.17	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.59	39	39	39				96.06	38	38	38										39	39	39				38	38	38			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	4	Preferred Generic	2	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	4.00	6.00				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												
S4802	077	0		29	10	S4802_077_0	4	Generic	2	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					6.00	12.00	18.00											13.00	26.00	39.00				6.00	12.00	18.00				13.00				13.00			0.43	0.2		0.43	0.2	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	4	Preferred Brand	2	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					38.00	76.00	114.00											46.00	92.00	138.00				38.00	76.00	114.00				46.00				46.00			1.53	1.27		1.53	1.27	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.67	37	37	37				96.01	36	36	36										37	37	37				36	36	36			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	4	Preferred Generic	2	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	4.00	6.00				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												
S4802	078	0		29	10	S4802_078_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					6.00	12.00	18.00											12.00	24.00	36.00				6.00	12.00	18.00				12.00				12.00			0.4	0.2		0.4	0.2	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	4	Preferred Brand	2	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	135.00				35.00	70.00	105.00				45.00				45.00			1.5	1.17		1.5	1.17	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.82	40	40	40				95.37	39	39	39										40	40	40				39	39	39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					9.00	18.00	27.00											17.00	34.00	51.00				9.00	18.00	27.00				17.00				17.00			0.57	0.3		0.57	0.3	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	4	Preferred Brand	2	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					35.00	70.00	105.00											44.00	88.00	132.00				35.00	70.00	105.00				44.00				44.00			1.47	1.17		1.47	1.17	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.11	39	39	39				95.6	38	38	38										39	39	39				38	38	38			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	4	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					0.00	0.00	0.00											3.00	6.00	9.00				0.00	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	4	Generic	2	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					6.00	12.00	18.00											14.00	28.00	42.00				6.00	12.00	18.00				14.00				14.00			0.47	0.2		0.47	0.2	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	4	Preferred Brand	2	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					39.00	78.00	117.00											45.00	90.00	135.00				39.00	78.00	117.00				45.00				45.00			1.5	1.3		1.5	1.3	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.26	42	42	42				93.58	40	40	40										42	42	42				40	40	40			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					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												
S4802	081	0		29	10	S4802_081_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					6.00	12.00	18.00											12.00	24.00	36.00				6.00	12.00	18.00				12.00				12.00			0.4	0.2		0.4	0.2	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	4	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					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												
S4802	081	0		29	10	S4802_081_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.65	38	38	38				96.06	37	37	37										38	38	38				37	37	37			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					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												
S4802	082	0		29	10	S4802_082_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00	22.00	33.00				5.00	10.00	15.00				11.00				11.00			0.37	0.17		0.37	0.17	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	4	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					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												
S4802	082	0		29	10	S4802_082_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.04	41	41	41				95.64	40	40	40										41	41	41				40	40	40			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	5	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					0.00	0.00	0.00											3.00	6.00	9.00				0.00	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	083	0		29	10	S4802_083_0	5	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					4.00	8.00	12.00											8.00	16.00	24.00				4.00	8.00	12.00				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	083	0		29	10	S4802_083_0	5	Preferred Brand	2	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					36.00	72.00	108.00											45.00	90.00	135.00				36.00	72.00	108.00				45.00				45.00			1.5	1.2		1.5	1.2	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.37	42	42	42				94.64	40	40	40										42	42	42				40	40	40			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	5	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	4	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					0.00	0.00	0.00											3.00	6.00	9.00				0.00	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	084	0		29	10	S4802_084_0	4	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					4.00	8.00	12.00											8.00	16.00	24.00				4.00	8.00	12.00				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	084	0		29	10	S4802_084_0	4	Preferred Brand	2	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					36.00	72.00	108.00											46.00	92.00	138.00				36.00	72.00	108.00				46.00				46.00			1.53	1.2		1.53	1.2	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.76	38	38	38				95.19	37	37	37										38	38	38				37	37	37			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00				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	085	0		29	10	S4802_085_0	4	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					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												
S4802	085	0		29	10	S4802_085_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.51	36	36	36				94.8	35	35	35										36	36	36				35	35	35			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				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	086	0		29	10	S4802_086_0	4	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					39.00	78.00	117.00											47.00	94.00	141.00				39.00	78.00	117.00				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	086	0		29	10	S4802_086_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.6	37	37	37				96.91	36	36	36										37	37	37				36	36	36			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				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	087	0		29	10	S4802_087_0	4	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					39.00	78.00	117.00											47.00	94.00	141.00				39.00	78.00	117.00				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	087	0		29	10	S4802_087_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.95	42	42	42				94.24	40	40	40										42	42	42				40	40	40			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					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												
S4802	088	0		29	10	S4802_088_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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												
S4802	088	0		29	10	S4802_088_0	4	Preferred Brand	2	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	135.00				35.00	70.00	105.00				45.00				45.00			1.5	1.17		1.5	1.17	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.94	39	39	39				96.4	38	38	38										39	39	39				38	38	38			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	5	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					0.00	0.00	0.00											3.00	6.00	9.00				0.00	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	089	0		29	10	S4802_089_0	5	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					5.00	10.00	15.00											9.00	18.00	27.00				5.00	10.00	15.00				9.00				9.00			0.3	0.17		0.3	0.17	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	5	Preferred Brand	2	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					37.00	74.00	111.00											45.00	90.00	135.00				37.00	74.00	111.00				45.00				45.00			1.5	1.23		1.5	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.43	41	41	41				94.58	39	39	39										41	41	41				39	39	39			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	5	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00	22.00	33.00				5.00	10.00	15.00				11.00				11.00			0.37	0.17		0.37	0.17	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	4	Preferred Brand	2	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					37.00	74.00	111.00											45.00	90.00	135.00				37.00	74.00	111.00				45.00				45.00			1.5	1.23		1.5	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.07	45	45	45				93.71	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				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	091	0		29	10	S4802_091_0	4	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					39.00	78.00	117.00											47.00	94.00	141.00				39.00	78.00	117.00				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	091	0		29	10	S4802_091_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.77	40	40	40				95.33	39	39	39										40	40	40				39	39	39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	5	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	18.00				0.00	0.00	0.00				6.00				6.00			0.2	0.00		0.2	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	5	Generic	2	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					6.00	12.00	18.00											13.00	26.00	39.00				6.00	12.00	18.00				13.00				13.00			0.43	0.2		0.43	0.2	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	5	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					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												
S4802	092	0		29	10	S4802_092_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.99	42	42	42				95.23	40	40	40										42	42	42				40	40	40			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	5	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	4	Preferred Generic	2	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	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												
S4802	093	0		29	10	S4802_093_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					7.00	14.00	21.00											14.00	28.00	42.00				7.00	14.00	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												
S4802	093	0		29	10	S4802_093_0	4	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					39.00	78.00	117.00											47.00	94.00	141.00				39.00	78.00	117.00				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	093	0		29	10	S4802_093_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.25	41	41	41				96.83	40	40	40										41	41	41				40	40	40			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	18.00				0.00	0.00	0.00				6.00				6.00			0.2	0.00		0.2	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					7.00	14.00	21.00											14.00	28.00	42.00				7.00	14.00	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												
S4802	094	0		29	10	S4802_094_0	4	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					39.00	78.00	117.00											47.00	94.00	141.00				39.00	78.00	117.00				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	094	0		29	10	S4802_094_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.1	36	36	36				95.38	35	35	35										36	36	36				35	35	35			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					0.00	0.00	0.00											18.00	36.00	54.00				0.00	0.00	0.00				18.00				18.00			0.6	0.00		0.6	0.00	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	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												
S4802	095	0		29	10	S4802_095_0	4	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					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				47.00			1.57	1.5		1.57	1.5	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.01	36	36	36				96.26	35	35	35										36	36	36				35	35	35			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	4	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	36.00				20.00				20.00			0.67	0.4		0.67	0.4	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	4	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											38.30	24	24	24				36.70	23	23	23										24	24	24				23	23	23			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.02	40	40	40				93.12	38	38	38										40	40	40				38	38	38			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	4	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					0.00	0.00	0.00											3.00	6.00	9.00				0.00	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	097	0		29	10	S4802_097_0	4	Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	12.00				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	097	0		29	10	S4802_097_0	4	Preferred Brand	2	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					35.00	70.00	105.00											44.00	88.00	132.00				35.00	70.00	105.00				44.00				44.00			1.47	1.17		1.47	1.17	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.39	37	37	37				97.39	37	37	37										37	37	37				37	37	37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	132	0		29	10	S4802_132_0	4	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					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												
S4802	132	0		29	10	S4802_132_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	132	0		29	10	S4802_132_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	132	0		29	10	S4802_132_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.53	50	50	50				55.02	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	132	0		29	10	S4802_132_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												
S4802	133	0		29	10	S4802_133_0	4	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					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												
S4802	133	0		29	10	S4802_133_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	133	0		29	10	S4802_133_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	133	0		29	10	S4802_133_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.75	50	50	50				54.29	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	133	0		29	10	S4802_133_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												
S4802	134	0		29	10	S4802_134_0	3	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					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												
S4802	134	0		29	10	S4802_134_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	134	0		29	10	S4802_134_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	134	0		29	10	S4802_134_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											60.33	50	50	50				56.71	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	134	0		29	10	S4802_134_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	135	0		29	10	S4802_135_0	3	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					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												
S4802	135	0		29	10	S4802_135_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	135	0		29	10	S4802_135_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	135	0		29	10	S4802_135_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											55.51	50	50	50				52.18	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	135	0		29	10	S4802_135_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	136	0		29	10	S4802_136_0	3	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					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												
S4802	136	0		29	10	S4802_136_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	136	0		29	10	S4802_136_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	136	0		29	10	S4802_136_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.36	50	50	50				53.92	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	136	0		29	10	S4802_136_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	137	0		29	10	S4802_137_0	3	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					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												
S4802	137	0		29	10	S4802_137_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	137	0		29	10	S4802_137_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	137	0		29	10	S4802_137_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.05	50	50	50				59.27	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	137	0		29	10	S4802_137_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												
S4802	138	0		29	10	S4802_138_0	3	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					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												
S4802	138	0		29	10	S4802_138_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	138	0		29	10	S4802_138_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	138	0		29	10	S4802_138_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											72.79	50	50	50				68.42	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	138	0		29	10	S4802_138_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												
S4802	139	0		29	10	S4802_139_0	3	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					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												
S4802	139	0		29	10	S4802_139_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	139	0		29	10	S4802_139_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	139	0		29	10	S4802_139_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											64.79	50	50	50				60.9	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	139	0		29	10	S4802_139_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	140	0		29	10	S4802_140_0	3	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					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												
S4802	140	0		29	10	S4802_140_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	140	0		29	10	S4802_140_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	140	0		29	10	S4802_140_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											60.46	50	50	50				56.83	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	140	0		29	10	S4802_140_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												
S4802	141	0		29	10	S4802_141_0	3	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					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												
S4802	141	0		29	10	S4802_141_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	141	0		29	10	S4802_141_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	141	0		29	10	S4802_141_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.59	50	50	50				51.32	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	141	0		29	10	S4802_141_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												
S4802	142	0		29	10	S4802_142_0	3	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					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												
S4802	142	0		29	10	S4802_142_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	142	0		29	10	S4802_142_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	142	0		29	10	S4802_142_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											56.74	50	50	50				53.33	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	142	0		29	10	S4802_142_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												
S4802	143	0		29	10	S4802_143_0	3	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					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												
S4802	143	0		29	10	S4802_143_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	143	0		29	10	S4802_143_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	143	0		29	10	S4802_143_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.68	50	50	50				50.46	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	143	0		29	10	S4802_143_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												
S4802	144	0		29	10	S4802_144_0	3	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					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												
S4802	144	0		29	10	S4802_144_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	144	0		29	10	S4802_144_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	144	0		29	10	S4802_144_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											52.89	50	50	50				49.71	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	144	0		29	10	S4802_144_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												
S4802	145	0		29	10	S4802_145_0	3	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					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												
S4802	145	0		29	10	S4802_145_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	145	0		29	10	S4802_145_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	145	0		29	10	S4802_145_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.33	50	50	50				53.89	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	145	0		29	10	S4802_145_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												
S4802	146	0		29	10	S4802_146_0	3	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					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												
S4802	146	0		29	10	S4802_146_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	146	0		29	10	S4802_146_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	146	0		29	10	S4802_146_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.22	50	50	50				53.79	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	146	0		29	10	S4802_146_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												
S4802	147	0		29	10	S4802_147_0	3	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					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												
S4802	147	0		29	10	S4802_147_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	147	0		29	10	S4802_147_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	147	0		29	10	S4802_147_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.49	50	50	50				54.04	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	147	0		29	10	S4802_147_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												
S4802	148	0		29	10	S4802_148_0	3	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					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												
S4802	148	0		29	10	S4802_148_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	148	0		29	10	S4802_148_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	148	0		29	10	S4802_148_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.82	50	50	50				48.71	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	148	0		29	10	S4802_148_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												
S4802	149	0		29	10	S4802_149_0	3	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					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												
S4802	149	0		29	10	S4802_149_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	149	0		29	10	S4802_149_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	149	0		29	10	S4802_149_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											56.33	50	50	50				52.95	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	149	0		29	10	S4802_149_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	150	0		29	10	S4802_150_0	3	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					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												
S4802	150	0		29	10	S4802_150_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	150	0		29	10	S4802_150_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	150	0		29	10	S4802_150_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.4	50	50	50				53.96	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	150	0		29	10	S4802_150_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												
S4802	151	0		29	10	S4802_151_0	3	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					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												
S4802	151	0		29	10	S4802_151_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	151	0		29	10	S4802_151_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	151	0		29	10	S4802_151_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.74	50	50	50				55.21	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	151	0		29	10	S4802_151_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	152	0		29	10	S4802_152_0	3	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					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												
S4802	152	0		29	10	S4802_152_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	152	0		29	10	S4802_152_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	152	0		29	10	S4802_152_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.84	50	50	50				50.61	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	152	0		29	10	S4802_152_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	153	0		29	10	S4802_153_0	3	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					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												
S4802	153	0		29	10	S4802_153_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	153	0		29	10	S4802_153_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	153	0		29	10	S4802_153_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.59	50	50	50				50.37	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	153	0		29	10	S4802_153_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												
S4802	154	0		29	10	S4802_154_0	3	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					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												
S4802	154	0		29	10	S4802_154_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	154	0		29	10	S4802_154_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	154	0		29	10	S4802_154_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											55.22	50	50	50				51.91	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	154	0		29	10	S4802_154_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	155	0		29	10	S4802_155_0	3	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					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												
S4802	155	0		29	10	S4802_155_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	155	0		29	10	S4802_155_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	155	0		29	10	S4802_155_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.44	50	50	50				54.93	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	155	0		29	10	S4802_155_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	156	0		29	10	S4802_156_0	3	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					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												
S4802	156	0		29	10	S4802_156_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	156	0		29	10	S4802_156_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	156	0		29	10	S4802_156_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											56.23	50	50	50				52.86	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	156	0		29	10	S4802_156_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	157	0		29	10	S4802_157_0	3	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					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												
S4802	157	0		29	10	S4802_157_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	157	0		29	10	S4802_157_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	157	0		29	10	S4802_157_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.06	50	50	50				49.88	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	157	0		29	10	S4802_157_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	158	0		29	10	S4802_158_0	3	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					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												
S4802	158	0		29	10	S4802_158_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	158	0		29	10	S4802_158_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	158	0		29	10	S4802_158_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											52.75	50	50	50				49.59	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	158	0		29	10	S4802_158_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												
S4802	159	0		29	10	S4802_159_0	3	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					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												
S4802	159	0		29	10	S4802_159_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	159	0		29	10	S4802_159_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	159	0		29	10	S4802_159_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.84	50	50	50				54.37	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	159	0		29	10	S4802_159_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	160	0		29	10	S4802_160_0	3	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					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												
S4802	160	0		29	10	S4802_160_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	160	0		29	10	S4802_160_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	160	0		29	10	S4802_160_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.55	50	50	50				51.28	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	160	0		29	10	S4802_160_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	161	0		29	10	S4802_161_0	3	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					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												
S4802	161	0		29	10	S4802_161_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	161	0		29	10	S4802_161_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	161	0		29	10	S4802_161_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											60.15	50	50	50				56.54	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	161	0		29	10	S4802_161_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												
S4802	162	0		29	10	S4802_162_0	3	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					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												
S4802	162	0		29	10	S4802_162_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	162	0		29	10	S4802_162_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	162	0		29	10	S4802_162_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.77	50	50	50				48.67	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	162	0		29	10	S4802_162_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												
S4802	163	0		29	10	S4802_163_0	3	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					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												
S4802	163	0		29	10	S4802_163_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	163	0		29	10	S4802_163_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	163	0		29	10	S4802_163_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.09	50	50	50				65.88	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	163	0		29	10	S4802_163_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	164	0		29	10	S4802_164_0	3	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					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												
S4802	164	0		29	10	S4802_164_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	164	0		29	10	S4802_164_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	164	0		29	10	S4802_164_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											60.5	50	50	50				56.87	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	164	0		29	10	S4802_164_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	165	0		29	10	S4802_165_0	3	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					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												
S4802	165	0		29	10	S4802_165_0	3	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					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				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	165	0		29	10	S4802_165_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	165	0		29	10	S4802_165_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											52.29	50	50	50				49.15	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	165	0		29	10	S4802_165_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	204	0		29	10	S4802_204_0	4	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	204	0		29	10	S4802_204_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	204	0		29	10	S4802_204_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	204	0		29	10	S4802_204_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											72.97	50	50	50				72.97	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	204	0		29	10	S4802_204_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	205	0		29	10	S4802_205_0	4	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	205	0		29	10	S4802_205_0	4	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	205	0		29	10	S4802_205_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	205	0		29	10	S4802_205_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.01	50	50	50				81.01	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	205	0		29	10	S4802_205_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	206	0		29	10	S4802_206_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	206	0		29	10	S4802_206_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	206	0		29	10	S4802_206_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	206	0		29	10	S4802_206_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.72	50	50	50				90.72	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	206	0		29	10	S4802_206_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	207	0		29	10	S4802_207_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	207	0		29	10	S4802_207_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	207	0		29	10	S4802_207_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	207	0		29	10	S4802_207_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											83.12	50	50	50				83.12	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	207	0		29	10	S4802_207_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	208	0		29	10	S4802_208_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	208	0		29	10	S4802_208_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	208	0		29	10	S4802_208_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	208	0		29	10	S4802_208_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											79.05	50	50	50				79.05	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	208	0		29	10	S4802_208_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	209	0		29	10	S4802_209_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	209	0		29	10	S4802_209_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	209	0		29	10	S4802_209_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	209	0		29	10	S4802_209_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											71.5	50	50	50				71.5	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	209	0		29	10	S4802_209_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	210	0		29	10	S4802_210_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	210	0		29	10	S4802_210_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	210	0		29	10	S4802_210_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	210	0		29	10	S4802_210_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											71.72	50	50	50				71.72	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	210	0		29	10	S4802_210_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	211	0		29	10	S4802_211_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	211	0		29	10	S4802_211_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	211	0		29	10	S4802_211_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	211	0		29	10	S4802_211_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											72.35	50	50	50				72.35	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	211	0		29	10	S4802_211_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	212	0		29	10	S4802_212_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	212	0		29	10	S4802_212_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	212	0		29	10	S4802_212_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	212	0		29	10	S4802_212_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											71.37	50	50	50				71.37	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	212	0		29	10	S4802_212_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	213	0		29	10	S4802_213_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	213	0		29	10	S4802_213_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	213	0		29	10	S4802_213_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	213	0		29	10	S4802_213_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											74.39	50	50	50				74.39	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	213	0		29	10	S4802_213_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	214	0		29	10	S4802_214_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	214	0		29	10	S4802_214_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	214	0		29	10	S4802_214_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	214	0		29	10	S4802_214_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											76.47	50	50	50				76.47	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	214	0		29	10	S4802_214_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	215	0		29	10	S4802_215_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	215	0		29	10	S4802_215_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	215	0		29	10	S4802_215_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	215	0		29	10	S4802_215_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.81	50	50	50				73.81	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	215	0		29	10	S4802_215_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	216	0		29	10	S4802_216_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	216	0		29	10	S4802_216_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	216	0		29	10	S4802_216_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	216	0		29	10	S4802_216_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.21	50	50	50				73.21	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	216	0		29	10	S4802_216_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	217	0		29	10	S4802_217_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	217	0		29	10	S4802_217_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	217	0		29	10	S4802_217_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	217	0		29	10	S4802_217_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.33	50	50	50				70.33	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	217	0		29	10	S4802_217_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	218	0		29	10	S4802_218_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	218	0		29	10	S4802_218_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	218	0		29	10	S4802_218_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	218	0		29	10	S4802_218_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											72.43	50	50	50				72.43	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	218	0		29	10	S4802_218_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	219	0		29	10	S4802_219_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	219	0		29	10	S4802_219_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	219	0		29	10	S4802_219_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	219	0		29	10	S4802_219_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											80.71	50	50	50				80.71	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	219	0		29	10	S4802_219_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	220	0		29	10	S4802_220_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	220	0		29	10	S4802_220_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	220	0		29	10	S4802_220_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	220	0		29	10	S4802_220_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.02	50	50	50				73.02	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	220	0		29	10	S4802_220_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	221	0		29	10	S4802_221_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	221	0		29	10	S4802_221_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	221	0		29	10	S4802_221_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	221	0		29	10	S4802_221_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.43	50	50	50				73.43	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	221	0		29	10	S4802_221_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	222	0		29	10	S4802_222_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	222	0		29	10	S4802_222_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	222	0		29	10	S4802_222_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	222	0		29	10	S4802_222_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											65.27	50	50	50				65.27	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	222	0		29	10	S4802_222_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	223	0		29	10	S4802_223_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	223	0		29	10	S4802_223_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	223	0		29	10	S4802_223_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	223	0		29	10	S4802_223_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											68.78	50	50	50				68.78	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	223	0		29	10	S4802_223_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	224	0		29	10	S4802_224_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	224	0		29	10	S4802_224_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	224	0		29	10	S4802_224_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	224	0		29	10	S4802_224_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											80.59	50	50	50				80.59	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	224	0		29	10	S4802_224_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	225	0		29	10	S4802_225_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	225	0		29	10	S4802_225_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	225	0		29	10	S4802_225_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	225	0		29	10	S4802_225_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.65	50	50	50				75.65	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	225	0		29	10	S4802_225_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	226	0		29	10	S4802_226_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	226	0		29	10	S4802_226_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	226	0		29	10	S4802_226_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	226	0		29	10	S4802_226_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											69.62	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												
S4802	226	0		29	10	S4802_226_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	227	0		29	10	S4802_227_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	227	0		29	10	S4802_227_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	227	0		29	10	S4802_227_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	227	0		29	10	S4802_227_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											68.27	50	50	50				68.27	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	227	0		29	10	S4802_227_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	228	0		29	10	S4802_228_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	228	0		29	10	S4802_228_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	228	0		29	10	S4802_228_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	228	0		29	10	S4802_228_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.94	50	50	50				70.94	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	228	0		29	10	S4802_228_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	229	0		29	10	S4802_229_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	229	0		29	10	S4802_229_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	229	0		29	10	S4802_229_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	229	0		29	10	S4802_229_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											77.24	50	50	50				77.24	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	229	0		29	10	S4802_229_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	230	0		29	10	S4802_230_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	230	0		29	10	S4802_230_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	230	0		29	10	S4802_230_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	230	0		29	10	S4802_230_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											78.35	50	50	50				78.35	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	230	0		29	10	S4802_230_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	231	0		29	10	S4802_231_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	231	0		29	10	S4802_231_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	231	0		29	10	S4802_231_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	231	0		29	10	S4802_231_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											66.51	50	50	50				66.51	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	231	0		29	10	S4802_231_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	232	0		29	10	S4802_232_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	232	0		29	10	S4802_232_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	232	0		29	10	S4802_232_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	232	0		29	10	S4802_232_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											79.54	50	50	50				79.54	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	232	0		29	10	S4802_232_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	233	0		29	10	S4802_233_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	233	0		29	10	S4802_233_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	233	0		29	10	S4802_233_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	233	0		29	10	S4802_233_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											72.36	50	50	50				72.36	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	233	0		29	10	S4802_233_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	234	0		29	10	S4802_234_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	234	0		29	10	S4802_234_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	234	0		29	10	S4802_234_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	234	0		29	10	S4802_234_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											66.97	50	50	50				66.97	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	234	0		29	10	S4802_234_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	235	0		29	10	S4802_235_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	235	0		29	10	S4802_235_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	235	0		29	10	S4802_235_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	235	0		29	10	S4802_235_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											84.7	50	50	50				84.7	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	235	0		29	10	S4802_235_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	236	0		29	10	S4802_236_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	236	0		29	10	S4802_236_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	236	0		29	10	S4802_236_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	236	0		29	10	S4802_236_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											79.45	50	50	50				79.45	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	236	0		29	10	S4802_236_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	237	0		29	10	S4802_237_0	3	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	237	0		29	10	S4802_237_0	3	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	237	0		29	10	S4802_237_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	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												
S4802	237	0		29	10	S4802_237_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											83.53	50	50	50				83.53	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	237	0		29	10	S4802_237_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	3	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	3	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	3	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.69	50	50	50				98.90	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3	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	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.64	49	49	49				92.80	45	45	45										49	49	49				45	45	45			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_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												
S5552	004	0		29	10	S5552_004_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											42.00	21		21				38.00	19		19										21		21				19		15			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											98.00	40		40				96.00	39		39										40		40				39		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											99.00	47		47				82.00	39		39										47		47				39		39			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	006	0		29	10	S5552_006_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	006	0		29	10	S5552_006_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		6.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	006	0		29	10	S5552_006_0	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	14		14				24.00	13		13										14		14				13		13			14			14								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	006	0		29	10	S5552_006_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											96.00	50		50				86.00	45		45										50		50				45		45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	006	0		29	10	S5552_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	4	Preferred Generic	3	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	001	0		29	10	S5584_001_0	4	Generic	3	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	001	0		29	10	S5584_001_0	4	Preferred Brand	3	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								40.00		120.00					35.00		105.00											40.00		120.00				35.00		105.00				40.00				40.00			1.29	1.13		1.29	1.13	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											96.00	45		45				92.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	4	Specialty Tier	3	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											61.00	45		45				61.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	3	Preferred Generic	2	01	1	2	1	1		110	01	100		1				31		90	1	2			90				31		31								6.00		18.00					0.00		0.00							0.00																6.00				6.00			0.19	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	3	Generic	2	01	1	2	2	1		110	01	100		1				31		90	1	2			90				31		31								14.00		42.00					7.00		21.00							17.50																14.00				14.00			0.45	0.23				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	3	Preferred Brand	2	11	1	1	3	1		110	01	100		1				31		90	1	2			90				31		31											58.70	25		25				58.70	20		20						20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01	100		1				31		90	1	2			90				31		31											81.54	50		50				81.54	40		40						40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	3	Specialty Tier	2	11	1	1	5	1		010	01	010		1				31					31						31		31											1072.21	25						1072.21	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	3	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							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	3	Preferred Generic	4	01	1	1	1	3		110	01	100		1				31		90	1	2			90				31		31											1.13	15		15				1.13	10		10						10															15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5593	003	0		29	10	S5593_003_0	3	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							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	3	Generic	4	01	1	1	2	3		110	01	100		1				31		90	1	2			90				31		31											3.61	15		15				3.61	10		10						10															15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5593	003	0		29	10	S5593_003_0	3	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							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	3	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				31		90	1	2			90				31		31											74.85	50		50				74.85	35		35						35															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1422.56	33						1422.56	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	4	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	4	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											78.03	50	50	50				78.03	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	4	Specialty Tier	4	11	1	1	5	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	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	3.00																5.00				5.00			0.17	0.03	0.03			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	4	Generic	3	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	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	4	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					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											88.45	35	35	35				88.45	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	4	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	4	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											70.17	50	50	50				70.17	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	4	Specialty Tier	4	11	1	1	5	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	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	3.00																5.00				5.00			0.17	0.03	0.03			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	4	Generic	3	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					5.00	10.00	15.00					5.00	10.00	15.00																9.00				9.00			0.30	0.17	0.17			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	4	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					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											88.98	35	35	35				88.98	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	4	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	4	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											68.79	50	50	50				68.79	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	4	Specialty Tier	4	11	1	1	5	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	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	3.00																5.00				5.00			0.17	0.03	0.03			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	4	Generic	3	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					5.00	10.00	15.00					5.00	10.00	15.00																8.00				8.00			0.27	0.17	0.17			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	4	Preferred Brand	3	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	84.00	126.00																42.00				42.00			1.40	1.40	1.40			1.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											87.93	35	35	35				87.93	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	4	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	4	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											70.16	50	50	50				70.16	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	4	Specialty Tier	4	11	1	1	5	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	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	3.00																5.00				5.00			0.17	0.03	0.03			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	4	Generic	3	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					5.00	10.00	15.00					5.00	10.00	15.00																8.00				8.00			0.27	0.17	0.17			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	4	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								32.00	64.00	96.00					32.00	64.00	96.00					32.00	64.00	96.00																32.00				32.00			1.07	1.07	1.07			0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											88.78	37	37	37				88.78	37	37	37				37	37	37															37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	4	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	4	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											69.50	50	50	50				69.50	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	4	Specialty Tier	4	11	1	1	5	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	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	3.00																5.00				5.00			0.17	0.03	0.03			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	4	Generic	3	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	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	4	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					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											89.88	35	35	35				89.88	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	3.00																5.00				5.00			0.17	0.03	0.03			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	4	Generic	3	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					4.00	8.00	12.00					4.00	8.00	12.00																10.00				10.00			0.33	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	4	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					37.00	74.00	111.00					37.00	74.00	111.00																37.00				37.00			1.23	1.23	1.23			1.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											92.05	36	36	36				92.05	36	36	36				36	36	36															36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	4	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	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	4	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	4	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											68.53	50	50	50				68.53	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	4	Specialty Tier	4	11	1	1	5	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	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	3.00																5.00				5.00			0.17	0.03	0.03			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	4	Generic	3	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					4.00	8.00	12.00					4.00	8.00	12.00																10.00				10.00			0.33	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	4	Preferred Brand	3	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	88.00	132.00																44.00				44.00			1.47	1.47	1.47			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											99.28	34	34	34				99.28	34	34	34				34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	4	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	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	4	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	4	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											82.22	50	50	50				82.22	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	4	Specialty Tier	4	11	1	1	5	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	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	3.00																5.00				5.00			0.17	0.03	0.03			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	4	Generic	3	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					4.00	8.00	12.00					4.00	8.00	12.00																10.00				10.00			0.33	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	4	Preferred Brand	3	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	88.00	132.00																44.00				44.00			1.47	1.47	1.47			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											99.20	34	34	34				99.20	34	34	34				34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	4	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	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	4	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	4	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											75.96	50	50	50				75.96	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	4	Specialty Tier	4	11	1	1	5	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	085	0		29	10	S5596_085_0	3	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	3.00																5.00				5.00			0.17	0.03	0.03			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	085	0		29	10	S5596_085_0	3	Generic	3	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					4.00	8.00	12.00					4.00	8.00	12.00																10.00				10.00			0.33	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	085	0		29	10	S5596_085_0	3	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					46.00	92.00	138.00					46.00	92.00	138.00																46.00				46.00			1.53	1.53	1.53			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	085	0		29	10	S5596_085_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											94.31	35	35	35				94.31	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	085	0		29	10	S5596_085_0	3	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	086	0		29	10	S5596_086_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	086	0		29	10	S5596_086_0	3	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	086	0		29	10	S5596_086_0	3	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	086	0		29	10	S5596_086_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											80.63	50	50	50				80.63	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	086	0		29	10	S5596_086_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	087	0		29	10	S5596_087_0	3	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	3.00																5.00				5.00			0.17	0.03	0.03			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	087	0		29	10	S5596_087_0	3	Generic	3	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					4.00	8.00	12.00					4.00	8.00	12.00																10.00				10.00			0.33	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	087	0		29	10	S5596_087_0	3	Preferred Brand	3	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	84.00	126.00																42.00				42.00			1.40	1.40	1.40			1.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	087	0		29	10	S5596_087_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											99.00	34	34	34				99.00	34	34	34				34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	087	0		29	10	S5596_087_0	3	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	088	0		29	10	S5596_088_0	3	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	088	0		29	10	S5596_088_0	3	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	088	0		29	10	S5596_088_0	3	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	088	0		29	10	S5596_088_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											92.05	50	50	50				92.05	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	088	0		29	10	S5596_088_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	2	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												
S5601	002	0		29	10	S5601_002_0	2	Generic	3	11	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												
S5601	002	0		29	10	S5601_002_0	2	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.44	17	17	17				35.53	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.76	35	35	35				62.47	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	2	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											926.35	25						782.38	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	1	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												
S5601	003	0		29	10	S5601_003_0	1	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	1	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												
S5601	003	0		29	10	S5601_003_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	003	0		29	10	S5601_003_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											84.64	50	50	50				59.42	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1082.50	33						703.90	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	004	0		29	10	S5601_004_0	1	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								11.00	22.00	33.00					5.00	10.00	15.00											11.00	22.00	33.00				5.00	10.00	15.00					11.00			11.00			0.37	0.17		0.37	0.17	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											27.09	17	17	17				33.56	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.69	35	35	35				61.77	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											949.03	25						618.84	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	1	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												
S5601	005	0		29	10	S5601_005_0	1	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	1	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												
S5601	005	0		29	10	S5601_005_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	005	0		29	10	S5601_005_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											90.39	50	50	50				80.18	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1193.41	33						592.01	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	006	0		29	10	S5601_006_0	1	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												
S5601	006	0		29	10	S5601_006_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.01	17	17	17				35.13	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.16	34	34	34				68.36	34	34	34										34	34	34				34	34	34				34		34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											736.81	25						553.42	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	1	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												
S5601	007	0		29	10	S5601_007_0	1	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	1	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												
S5601	007	0		29	10	S5601_007_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	007	0		29	10	S5601_007_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.34	50	50	50				79.81	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1070.88	33						647.82	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	008	0		29	10	S5601_008_0	1	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												
S5601	008	0		29	10	S5601_008_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.81	17	17	17				36.94	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											82.85	38	38	38				66.27	38	38	38										38	38	38				38	38	38				38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											786.84	25						627.54	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	1	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												
S5601	009	0		29	10	S5601_009_0	1	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	1	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												
S5601	009	0		29	10	S5601_009_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	009	0		29	10	S5601_009_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											97.80	50	50	50				71.67	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1364.59	33						956.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	010	0		29	10	S5601_010_0	1	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												
S5601	010	0		29	10	S5601_010_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											27.51	17	17	17				36.77	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.65	37	37	37				62.32	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											880.77	25						785.02	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	1	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												
S5601	011	0		29	10	S5601_011_0	1	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	1	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												
S5601	011	0		29	10	S5601_011_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	011	0		29	10	S5601_011_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											91.81	50	50	50				64.79	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1198.13	33						863.04	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	012	0		29	10	S5601_012_0	1	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								11.00	22.00	33.00					5.00	10.00	15.00											11.00	22.00	33.00				5.00	10.00	15.00					11.00			11.00			0.37	0.17		0.37	0.17	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											28.55	17	17	17				37.35	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.63	41	41	41				72.29	41	41	41										41	41	41				41	41	41				41		41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1130.76	25						580.25	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	1	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												
S5601	013	0		29	10	S5601_013_0	1	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	1	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												
S5601	013	0		29	10	S5601_013_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	013	0		29	10	S5601_013_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											79.84	50	50	50				65.54	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1113.10	33						728.53	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	2	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												
S5601	014	0		29	10	S5601_014_0	2	Generic	3	11	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												
S5601	014	0		29	10	S5601_014_0	2	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											27.98	17	17	17				39.19	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.21	40	40	40				71.15	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	2	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											992.29	25						797.93	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	1	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												
S5601	015	0		29	10	S5601_015_0	1	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	1	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												
S5601	015	0		29	10	S5601_015_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	015	0		29	10	S5601_015_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.61	50	50	50				66.14	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1361.31	33						599.84	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	016	0		29	10	S5601_016_0	1	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	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			15.00			0.50	0.20		0.50	0.20	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.91	17	17	17				36.56	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.08	36	36	36				70.19	36	36	36										36	36	36				36	36	36				36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1047.89	25						819.52	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	1	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												
S5601	017	0		29	10	S5601_017_0	1	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	1	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												
S5601	017	0		29	10	S5601_017_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	017	0		29	10	S5601_017_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.63	50	50	50				60.83	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1356.52	33						444.89	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	1	Generic	3	11	1	2	2	1		111	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												
S5601	018	0		29	10	S5601_018_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											28.10	17	17	17				34.85	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.77	36	36	36				66.38	36	36	36										36	36	36				36	36	36				36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1075.54	25						941.88	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	1	Preferred Generic	4	01	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												
S5601	019	0		29	10	S5601_019_0	1	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	1	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												
S5601	019	0		29	10	S5601_019_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	019	0		29	10	S5601_019_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.25	50	50	50				59.52	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1284.61	33						1479.84	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								12.00	24.00	36.00					0.00	0.00	0.00											12.00	24.00	36.00				0.00	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												
S5601	020	0		29	10	S5601_020_0	1	Generic	3	11	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												
S5601	020	0		29	10	S5601_020_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											25.10	17	17	17				36.27	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.73	39	39	39				77.41	39	39	39										39	39	39				39	39	39				39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											956.04	25						841.13	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	1	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												
S5601	021	0		29	10	S5601_021_0	1	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	1	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												
S5601	021	0		29	10	S5601_021_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	021	0		29	10	S5601_021_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.26	50	50	50				63.61	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1373.42	33						885.61	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								12.00	24.00	36.00					0.00	0.00	0.00											12.00	24.00	36.00				0.00	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												
S5601	022	0		29	10	S5601_022_0	2	Generic	3	11	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												
S5601	022	0		29	10	S5601_022_0	2	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											25.21	17	17	17				34.12	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.03	35	35	35				69.32	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											787.08	25						745.93	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	1	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												
S5601	023	0		29	10	S5601_023_0	1	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	1	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												
S5601	023	0		29	10	S5601_023_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	023	0		29	10	S5601_023_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											87.29	50	50	50				67.44	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1304.52	33						896.08	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	024	0		29	10	S5601_024_0	1	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					5.00	10.00	15.00											13.00	26.00	39.00				5.00	10.00	15.00					13.00			13.00			0.43	0.17		0.43	0.17	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											27.30	17	17	17				37.25	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.83	39	39	39				69.23	39	39	39										39	39	39				39	39	39				39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1030.73	25						980.31	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	1	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												
S5601	025	0		29	10	S5601_025_0	1	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	1	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												
S5601	025	0		29	10	S5601_025_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	025	0		29	10	S5601_025_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.53	50	50	50				57.34	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1208.32	33						703.09	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	026	0		29	10	S5601_026_0	1	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												
S5601	026	0		29	10	S5601_026_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											26.36	17	17	17				35.67	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.09	37	37	37				69.33	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1069.11	25						652.40	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	1	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												
S5601	027	0		29	10	S5601_027_0	1	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	1	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												
S5601	027	0		29	10	S5601_027_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	027	0		29	10	S5601_027_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.51	50	50	50				56.97	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1358.88	33						736.92	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	1	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		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												
S5601	028	0		29	10	S5601_028_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											27.98	18	18	18				44.86	18	18	18										18	18	18				18	18	18				18		18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.44	40	40	40				69.06	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1091.75	25						757.04	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	1	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												
S5601	029	0		29	10	S5601_029_0	1	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	1	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												
S5601	029	0		29	10	S5601_029_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	029	0		29	10	S5601_029_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											84.06	50	50	50				65.77	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1267.01	33						803.57	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	030	0		29	10	S5601_030_0	1	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					5.00	10.00	15.00											13.00	26.00	39.00				5.00	10.00	15.00					13.00			13.00			0.43	0.17		0.43	0.17	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											26.39	17	17	17				37.94	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.29	38	38	38				71.18	38	38	38										38	38	38				38	38	38				38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1152.37	25						761.69	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	1	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												
S5601	031	0		29	10	S5601_031_0	1	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	1	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												
S5601	031	0		29	10	S5601_031_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	031	0		29	10	S5601_031_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.26	50	50	50				56.98	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1436.33	33						790.81	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	032	0		29	10	S5601_032_0	1	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												
S5601	032	0		29	10	S5601_032_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											26.43	17	17	17				35.24	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.68	36	36	36				59.22	36	36	36										36	36	36				36	36	36				36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											977.27	25						1028.36	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	1	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												
S5601	033	0		29	10	S5601_033_0	1	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	1	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												
S5601	033	0		29	10	S5601_033_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	033	0		29	10	S5601_033_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.77	50	50	50				54.55	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1115.76	33						745.37	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	034	0		29	10	S5601_034_0	1	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					5.00	10.00	15.00											13.00	26.00	39.00				5.00	10.00	15.00					13.00			13.00			0.43	0.17		0.43	0.17	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											28.58	17	17	17				41.04	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.11	40	40	40				74.36	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											974.05	25						950.06	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	1	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												
S5601	035	0		29	10	S5601_035_0	1	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	1	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												
S5601	035	0		29	10	S5601_035_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	035	0		29	10	S5601_035_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.30	50	50	50				70.49	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1388.65	33						839.94	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	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												
S5601	036	0		29	10	S5601_036_0	1	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					5.00	10.00	15.00											13.00	26.00	39.00				5.00	10.00	15.00					13.00			13.00			0.43	0.17		0.43	0.17	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											26.47	17	17	17				36.08	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.42	35	35	35				68.16	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											800.90	25						867.10	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	1	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												
S5601	037	0		29	10	S5601_037_0	1	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	1	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												
S5601	037	0		29	10	S5601_037_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	037	0		29	10	S5601_037_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.20	50	50	50				58.31	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											922.78	33						1197.57	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	038	0		29	10	S5601_038_0	1	Generic	3	11	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												
S5601	038	0		29	10	S5601_038_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											28.57	17	17	17				35.16	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.93	39	39	39				74.94	39	39	39										39	39	39				39	39	39				39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1202.73	25						1176.28	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	040	0		29	10	S5601_040_0	1	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												
S5601	040	0		29	10	S5601_040_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											28.75	17	17	17				37.23	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.23	38	38	38				68.80	38	38	38										38	38	38				38	38	38				38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											966.51	25						948.91	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	1	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												
S5601	041	0		29	10	S5601_041_0	1	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	1	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												
S5601	041	0		29	10	S5601_041_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	041	0		29	10	S5601_041_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.06	50	50	50				52.16	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1440.56	33						932.84	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	042	0		29	10	S5601_042_0	1	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								11.00	22.00	33.00					5.00	10.00	15.00											11.00	22.00	33.00				5.00	10.00	15.00					11.00			11.00			0.37	0.17		0.37	0.17	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											27.29	17	17	17				33.23	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.25	35	35	35				61.67	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											773.83	25						756.38	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	044	0		29	10	S5601_044_0	1	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												
S5601	044	0		29	10	S5601_044_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.29	17	17	17				36.33	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.36	38	38	38				71.64	38	38	38										38	38	38				38	38	38				38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1095.73	25						574.12	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	1	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												
S5601	045	0		29	10	S5601_045_0	1	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	1	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												
S5601	045	0		29	10	S5601_045_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	045	0		29	10	S5601_045_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.59	50	50	50				62.72	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1019.37	33						777.50	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	046	0		29	10	S5601_046_0	1	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												
S5601	046	0		29	10	S5601_046_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.21	17	17	17				35.51	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.63	38	38	38				64.76	38	38	38										38	38	38				38	38	38				38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1008.03	25						765.21	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	048	0		29	10	S5601_048_0	1	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												
S5601	048	0		29	10	S5601_048_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											27.42	17	17	17				37.39	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.92	35	35	35				61.92	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1079.46	25						874.96	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	1	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												
S5601	049	0		29	10	S5601_049_0	1	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	1	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												
S5601	049	0		29	10	S5601_049_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	049	0		29	10	S5601_049_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.77	50	50	50				57.72	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1322.74	33						805.15	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	050	0		29	10	S5601_050_0	1	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												
S5601	050	0		29	10	S5601_050_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											27.84	17	17	17				36.94	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.50	38	38	38				63.87	38	38	38										38	38	38				38	38	38				38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1067.76	25						754.44	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	1	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												
S5601	051	0		29	10	S5601_051_0	1	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	1	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												
S5601	051	0		29	10	S5601_051_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	051	0		29	10	S5601_051_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											71.72	50	50	50				67.15	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											891.17	33						619.33	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	052	0		29	10	S5601_052_0	1	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								16.00	32.00	48.00					5.00	10.00	15.00											16.00	32.00	48.00				5.00	10.00	15.00					16.00			16.00			0.53	0.17		0.53	0.17	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											30.38	17	17	17				35.35	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.00	37	37	37				62.26	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											908.54	25						812.28	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	1	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												
S5601	053	0		29	10	S5601_053_0	1	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	1	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												
S5601	053	0		29	10	S5601_053_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	053	0		29	10	S5601_053_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											92.46	50	50	50				68.57	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1317.68	33						739.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	054	0		29	10	S5601_054_0	1	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												
S5601	054	0		29	10	S5601_054_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.42	17	17	17				37.82	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.46	35	35	35				62.39	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											902.30	25						804.91	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	1	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												
S5601	055	0		29	10	S5601_055_0	1	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	1	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												
S5601	055	0		29	10	S5601_055_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	055	0		29	10	S5601_055_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											90.34	50	50	50				64.93	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1159.18	33						812.42	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	056	0		29	10	S5601_056_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												
S5601	056	0		29	10	S5601_056_0	2	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					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												
S5601	056	0		29	10	S5601_056_0	2	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											32.16	17	17	17				35.97	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.36	41	41	41				75.43	41	41	41										41	41	41				41	41	41				41		41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	2	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1207.49	25						783.98	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	1	Preferred Generic	4	01	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												
S5601	057	0		29	10	S5601_057_0	1	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	1	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												
S5601	057	0		29	10	S5601_057_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	057	0		29	10	S5601_057_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.67	50	50	50				68.37	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1338.32	33						878.72	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	1	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	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												
S5601	058	0		29	10	S5601_058_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											26.19	17	17	17				35.37	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											81.31	41	41	41				73.69	41	41	41										41	41	41				41	41	41				41		41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1035.69	25						945.52	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	1	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												
S5601	059	0		29	10	S5601_059_0	1	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	1	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												
S5601	059	0		29	10	S5601_059_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	059	0		29	10	S5601_059_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											93.64	50	50	50				68.70	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1274.47	33						758.04	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	060	0		29	10	S5601_060_0	1	Generic	3	11	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												
S5601	060	0		29	10	S5601_060_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											27.50	17	17	17				34.25	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.52	35	35	35				60.12	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1094.33	25						903.59	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	1	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												
S5601	061	0		29	10	S5601_061_0	1	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	1	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												
S5601	061	0		29	10	S5601_061_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	061	0		29	10	S5601_061_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											84.22	50	50	50				62.71	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											894.26	33						589.94	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	1	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								12.00	24.00	36.00					0.00	0.00	0.00											12.00	24.00	36.00				0.00	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												
S5601	062	0		29	10	S5601_062_0	1	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								17.00	34.00	51.00					5.00	10.00	15.00											17.00	34.00	51.00				5.00	10.00	15.00					17.00			17.00			0.57	0.17		0.57	0.17	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.51	17	17	17				38.35	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.60	35	35	35				64.94	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											999.42	25						642.48	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	1	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												
S5601	063	0		29	10	S5601_063_0	1	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	1	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												
S5601	063	0		29	10	S5601_063_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	063	0		29	10	S5601_063_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											86.10	50	50	50				64.04	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1193.26	33						729.42	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	064	0		29	10	S5601_064_0	1	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												
S5601	064	0		29	10	S5601_064_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											31.44	17	17	17				34.92	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.36	35	35	35				73.53	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											891.26	25						812.58	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	1	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												
S5601	065	0		29	10	S5601_065_0	1	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	1	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												
S5601	065	0		29	10	S5601_065_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	065	0		29	10	S5601_065_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											92.74	50	50	50				74.17	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1128.00	33						800.18	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	1	Preferred Generic	3	01	1	2	1	1		111	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												
S5601	066	0		29	10	S5601_066_0	1	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					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												
S5601	066	0		29	10	S5601_066_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											39.82	19	19	19				38.91	17	17	17										19	19	19				17	17	17				19		19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.82	34	34	34				78.62	34	34	34										34	34	34				34	34	34				34		34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1038.86	25						887.66	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	1	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												
S5601	067	0		29	10	S5601_067_0	1	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	1	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												
S5601	067	0		29	10	S5601_067_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	067	0		29	10	S5601_067_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.49	50	50	50				70.71	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1157.53	33						715.94	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	1	Preferred Generic	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												
S5601	068	0		29	10	S5601_068_0	1	Generic	3	11	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												
S5601	068	0		29	10	S5601_068_0	1	Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											25.67	17	17	17				36.08	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											55.66	35	35	35				58.22	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	1	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											970.16	25						858.62	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	1	Preferred Generic	4	01	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												
S5601	107	0		29	10	S5601_107_0	1	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	1	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												
S5601	107	0		29	10	S5601_107_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	107	0		29	10	S5601_107_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.69	50	50	50				50.12	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1492.34	33						930.59	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	1	Preferred Generic	4	01	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												
S5601	108	0		29	10	S5601_108_0	1	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	1	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												
S5601	108	0		29	10	S5601_108_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	108	0		29	10	S5601_108_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.64	50	50	50				58.68	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1082.16	33						787.24	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	1	Preferred Generic	4	01	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												
S5601	109	0		29	10	S5601_109_0	1	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	1	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												
S5601	109	0		29	10	S5601_109_0	1	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	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	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												
S5601	109	0		29	10	S5601_109_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.14	50	50	50				61.90	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											928.73	33						785.58	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	176	0		29	10	S5601_176_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	176	0		29	10	S5601_176_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	176	0		29	10	S5601_176_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	176	0		29	10	S5601_176_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											81.47	50	50	50				75.33	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	176	0		29	10	S5601_176_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											870.17	25						849.18	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	177	0		29	10	S5601_177_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	177	0		29	10	S5601_177_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	177	0		29	10	S5601_177_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	177	0		29	10	S5601_177_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											79.84	50	50	50				74.97	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	177	0		29	10	S5601_177_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											853.24	25						838.64	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	178	0		29	10	S5601_178_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	178	0		29	10	S5601_178_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	178	0		29	10	S5601_178_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	178	0		29	10	S5601_178_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											81.92	50	50	50				77.49	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	178	0		29	10	S5601_178_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											879.86	25						864.54	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	179	0		29	10	S5601_179_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	179	0		29	10	S5601_179_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	179	0		29	10	S5601_179_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	179	0		29	10	S5601_179_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											81.18	50	50	50				77.25	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	179	0		29	10	S5601_179_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											863.89	25						853.42	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	180	0		29	10	S5601_180_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	180	0		29	10	S5601_180_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	180	0		29	10	S5601_180_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	180	0		29	10	S5601_180_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											79.45	50	50	50				74.14	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	180	0		29	10	S5601_180_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											843.61	25						828.91	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	181	0		29	10	S5601_181_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	181	0		29	10	S5601_181_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	181	0		29	10	S5601_181_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	181	0		29	10	S5601_181_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											79.34	50	50	50				74.38	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	181	0		29	10	S5601_181_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											846.12	25						833.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	182	0		29	10	S5601_182_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	182	0		29	10	S5601_182_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	182	0		29	10	S5601_182_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	182	0		29	10	S5601_182_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.63	50	50	50				72.55	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	182	0		29	10	S5601_182_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											822.44	25						810.41	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	183	0		29	10	S5601_183_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	183	0		29	10	S5601_183_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	183	0		29	10	S5601_183_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	183	0		29	10	S5601_183_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.40	50	50	50				72.36	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	183	0		29	10	S5601_183_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											815.73	25						804.55	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	184	0		29	10	S5601_184_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	184	0		29	10	S5601_184_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	184	0		29	10	S5601_184_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	184	0		29	10	S5601_184_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.73	50	50	50				73.77	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	184	0		29	10	S5601_184_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											834.21	25						821.87	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	185	0		29	10	S5601_185_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	185	0		29	10	S5601_185_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	185	0		29	10	S5601_185_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	185	0		29	10	S5601_185_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.84	50	50	50				72.76	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	185	0		29	10	S5601_185_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											820.03	25						807.75	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	186	0		29	10	S5601_186_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	186	0		29	10	S5601_186_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	186	0		29	10	S5601_186_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	186	0		29	10	S5601_186_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.61	50	50	50				73.40	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	186	0		29	10	S5601_186_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											831.31	25						815.47	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	187	0		29	10	S5601_187_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	187	0		29	10	S5601_187_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	187	0		29	10	S5601_187_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	187	0		29	10	S5601_187_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.70	50	50	50				70.34	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	187	0		29	10	S5601_187_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											771.55	25						839.89	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	188	0		29	10	S5601_188_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	188	0		29	10	S5601_188_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	188	0		29	10	S5601_188_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	188	0		29	10	S5601_188_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.35	50	50	50				74.25	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	188	0		29	10	S5601_188_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											846.59	25						830.51	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	189	0		29	10	S5601_189_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	189	0		29	10	S5601_189_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	189	0		29	10	S5601_189_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	189	0		29	10	S5601_189_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.56	50	50	50				71.69	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	189	0		29	10	S5601_189_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											812.95	25						801.40	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	190	0		29	10	S5601_190_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	190	0		29	10	S5601_190_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	190	0		29	10	S5601_190_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	190	0		29	10	S5601_190_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.77	50	50	50				69.37	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	190	0		29	10	S5601_190_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											775.84	25						767.49	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	191	0		29	10	S5601_191_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	191	0		29	10	S5601_191_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	191	0		29	10	S5601_191_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	191	0		29	10	S5601_191_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.37	50	50	50				69.39	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	191	0		29	10	S5601_191_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											770.67	25						771.29	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	192	0		29	10	S5601_192_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	192	0		29	10	S5601_192_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	192	0		29	10	S5601_192_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	192	0		29	10	S5601_192_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.13	50	50	50				70.10	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	192	0		29	10	S5601_192_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											797.26	25						785.13	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	193	0		29	10	S5601_193_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	193	0		29	10	S5601_193_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	193	0		29	10	S5601_193_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	193	0		29	10	S5601_193_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.84	50	50	50				69.88	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	193	0		29	10	S5601_193_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											772.09	25						799.83	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	194	0		29	10	S5601_194_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	194	0		29	10	S5601_194_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	194	0		29	10	S5601_194_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	194	0		29	10	S5601_194_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.24	50	50	50				69.29	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	194	0		29	10	S5601_194_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											763.87	25						801.66	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	195	0		29	10	S5601_195_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	195	0		29	10	S5601_195_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	195	0		29	10	S5601_195_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	195	0		29	10	S5601_195_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.59	50	50	50				69.91	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	195	0		29	10	S5601_195_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											763.66	25						847.06	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	196	0		29	10	S5601_196_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	196	0		29	10	S5601_196_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	196	0		29	10	S5601_196_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	196	0		29	10	S5601_196_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.42	50	50	50				68.67	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	196	0		29	10	S5601_196_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											754.59	25						811.08	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	197	0		29	10	S5601_197_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	197	0		29	10	S5601_197_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	197	0		29	10	S5601_197_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	197	0		29	10	S5601_197_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.31	50	50	50				72.18	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	197	0		29	10	S5601_197_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											814.62	25						802.98	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	198	0		29	10	S5601_198_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	198	0		29	10	S5601_198_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	198	0		29	10	S5601_198_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	198	0		29	10	S5601_198_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.78	50	50	50				73.99	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	198	0		29	10	S5601_198_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											774.05	25						1054.79	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	199	0		29	10	S5601_199_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	199	0		29	10	S5601_199_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	199	0		29	10	S5601_199_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	199	0		29	10	S5601_199_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.05	50	50	50				68.83	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	199	0		29	10	S5601_199_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											762.77	25						773.45	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	200	0		29	10	S5601_200_0	1	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	200	0		29	10	S5601_200_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	200	0		29	10	S5601_200_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	200	0		29	10	S5601_200_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.87	50	50	50				69.89	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	200	0		29	10	S5601_200_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											790.03	25						778.82	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	201	0		29	10	S5601_201_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	201	0		29	10	S5601_201_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	201	0		29	10	S5601_201_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	201	0		29	10	S5601_201_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											83.57	50	50	50				74.21	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	201	0		29	10	S5601_201_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											865.70	25						836.92	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	202	0		29	10	S5601_202_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	202	0		29	10	S5601_202_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	202	0		29	10	S5601_202_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	202	0		29	10	S5601_202_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											84.66	50	50	50				79.50	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	202	0		29	10	S5601_202_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											909.64	25						887.57	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	203	0		29	10	S5601_203_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	203	0		29	10	S5601_203_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	203	0		29	10	S5601_203_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	203	0		29	10	S5601_203_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											83.92	50	50	50				75.38	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	203	0		29	10	S5601_203_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											873.90	25						846.67	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	204	0		29	10	S5601_204_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	204	0		29	10	S5601_204_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	204	0		29	10	S5601_204_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	204	0		29	10	S5601_204_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.54	50	50	50				75.32	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	204	0		29	10	S5601_204_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											857.50	25						833.97	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	205	0		29	10	S5601_205_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	205	0		29	10	S5601_205_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	205	0		29	10	S5601_205_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	205	0		29	10	S5601_205_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											83.16	50	50	50				74.78	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	205	0		29	10	S5601_205_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											878.01	25						846.45	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	206	0		29	10	S5601_206_0	2	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	206	0		29	10	S5601_206_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					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												
S5601	206	0		29	10	S5601_206_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					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												
S5601	206	0		29	10	S5601_206_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.56	50	50	50				71.94	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	206	0		29	10	S5601_206_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											815.58	25						802.38	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	207	0		29	10	S5601_207_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	207	0		29	10	S5601_207_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	207	0		29	10	S5601_207_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	207	0		29	10	S5601_207_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											82.64	50	50	50				77.60	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	207	0		29	10	S5601_207_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											884.07	25						868.12	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	208	0		29	10	S5601_208_0	2	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	208	0		29	10	S5601_208_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					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												
S5601	208	0		29	10	S5601_208_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					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												
S5601	208	0		29	10	S5601_208_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.98	50	50	50				78.09	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	208	0		29	10	S5601_208_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											931.69	25						893.91	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	209	0		29	10	S5601_209_0	1	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					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	3.00					19.00			19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	209	0		29	10	S5601_209_0	1	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					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												
S5601	209	0		29	10	S5601_209_0	1	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					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												
S5601	209	0		29	10	S5601_209_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											84.40	50	50	50				79.48	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	209	0		29	10	S5601_209_0	1	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											903.96	25						880.18	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	210	0		29	10	S5601_210_0	2	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												
S5601	210	0		29	10	S5601_210_0	2	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	210	0		29	10	S5601_210_0	2	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												
S5601	210	0		29	10	S5601_210_0	2	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	210	0		29	10	S5601_210_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	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												
S5601	210	0		29	10	S5601_210_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											93.27	50	50	50				66.17	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	210	0		29	10	S5601_210_0	2	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1314.33	33						806.76	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	2	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	2	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	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	2	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	2	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											77.68	45	45	45				69.05	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	2	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											939.22	26						939.22	26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	3	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	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	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	3	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				69.05	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	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1192.09	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	6	Preferred Generic	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					1.00	2.00	3.00											14.00	28.00	42.00				1.00	2.00	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, Select Care Drugs												
S5617	003	0		29	10	S5617_003_0	6	Generic	3	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					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	003	0		29	10	S5617_003_0	6	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	003	0		29	10	S5617_003_0	6	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											85.76	50	50	50				68.94	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	003	0		29	10	S5617_003_0	6	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	003	0		29	10	S5617_003_0	6	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S5617	008	0		29	10	S5617_008_0	5	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					1.00	2.00	3.00											14.00	28.00	42.00				1.00	2.00	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, Select Care Drugs												
S5617	008	0		29	10	S5617_008_0	5	Generic	3	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					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	008	0		29	10	S5617_008_0	5	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	008	0		29	10	S5617_008_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											81.04	50	50	50				73.27	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	008	0		29	10	S5617_008_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	008	0		29	10	S5617_008_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S5617	013	0		29	10	S5617_013_0	5	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					1.00	2.00	3.00											13.00	26.00	39.00				1.00	2.00	0.00				13.00				13.00			0.43	0.03		0.43	0.03	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	013	0		29	10	S5617_013_0	5	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								14.00	28.00	42.00					2.00	4.00	6.00											14.00	28.00	42.00				2.00	4.00	0.00				14.00				14.00			0.47	0.07		0.47	0.07	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	013	0		29	10	S5617_013_0	5	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								25.00	50.00	75.00					20.00	40.00	60.00											25.00	50.00	75.00				20.00	40.00	60.00				25.00				25.00			0.83	0.67		0.83	0.67	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	013	0		29	10	S5617_013_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											91.52	50	50	50				77.95	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	013	0		29	10	S5617_013_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	013	0		29	10	S5617_013_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
S5617	018	0		29	10	S5617_018_0	5	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					1.00	2.00	3.00											14.00	28.00	42.00				1.00	2.00	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, Select Care Drugs												
S5617	018	0		29	10	S5617_018_0	5	Generic	3	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					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	018	0		29	10	S5617_018_0	5	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	018	0		29	10	S5617_018_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											89.27	50	50	50				84.51	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	018	0		29	10	S5617_018_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	018	0		29	10	S5617_018_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	053	0		29	10	S5617_053_0	5	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					1.00	2.00	3.00											14.00	28.00	42.00				1.00	2.00	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, Select Care Drugs												
S5617	053	0		29	10	S5617_053_0	5	Generic	3	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					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	053	0		29	10	S5617_053_0	5	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	053	0		29	10	S5617_053_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											95.56	50	50	50				79.00	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	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	053	0		29	10	S5617_053_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	068	0		29	10	S5617_068_0	5	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	5	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	068	0		29	10	S5617_068_0	5	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	068	0		29	10	S5617_068_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											88.37	50	50	50				65.18	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	068	0		29	10	S5617_068_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	068	0		29	10	S5617_068_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	088	0		29	10	S5617_088_0	5	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	5	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	5	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	088	0		29	10	S5617_088_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											84.08	50	50	50				66.29	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	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	088	0		29	10	S5617_088_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S5617	103	0		29	10	S5617_103_0	5	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	5	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					4.00	8.00	12.00											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, Select Care Drugs												
S5617	103	0		29	10	S5617_103_0	5	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	103	0		29	10	S5617_103_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.14	46	46	46				82.10	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	103	0		29	10	S5617_103_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	103	0		29	10	S5617_103_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S5617	108	0		29	10	S5617_108_0	5	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	5	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	108	0		29	10	S5617_108_0	5	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	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.30	47	47	47				72.72	47	47	47										47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	108	0		29	10	S5617_108_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	108	0		29	10	S5617_108_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	113	0		29	10	S5617_113_0	5	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					1.00	2.00	3.00											14.00	28.00	42.00				1.00	2.00	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, Select Care Drugs												
S5617	113	0		29	10	S5617_113_0	5	Generic	3	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					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	113	0		29	10	S5617_113_0	5	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								31.00	62.00	93.00					21.00	42.00	63.00											31.00	62.00	93.00				21.00	42.00	63.00				31.00				31.00			1.03	0.70		1.03	0.70	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	113	0		29	10	S5617_113_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											87.38	50	50	50				79.26	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	113	0		29	10	S5617_113_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	113	0		29	10	S5617_113_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
S5617	118	0		29	10	S5617_118_0	5	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					1.00	2.00	3.00											14.00	28.00	42.00				1.00	2.00	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, Select Care Drugs												
S5617	118	0		29	10	S5617_118_0	5	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	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, Select Care Drugs												
S5617	118	0		29	10	S5617_118_0	5	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	118	0		29	10	S5617_118_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											77.38	50	50	50				58.58	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	118	0		29	10	S5617_118_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	118	0		29	10	S5617_118_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	123	0		29	10	S5617_123_0	5	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					1.00	2.00	3.00											14.00	28.00	42.00				1.00	2.00	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, Select Care Drugs												
S5617	123	0		29	10	S5617_123_0	5	Generic	3	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					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	123	0		29	10	S5617_123_0	5	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	123	0		29	10	S5617_123_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											84.04	50	50	50				71.43	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	123	0		29	10	S5617_123_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	123	0		29	10	S5617_123_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	128	0		29	10	S5617_128_0	5	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					11.00	22.00	33.00											19.00	38.00	57.00				11.00	22.00	0.00				19.00				19.00			0.63	0.37		0.63	0.37	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	128	0		29	10	S5617_128_0	5	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					20.00	40.00	60.00											20.00	40.00	60.00				20.00	40.00	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, Select Care Drugs												
S5617	128	0		29	10	S5617_128_0	5	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	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.06	43	43	43				73.77	43	43	43										43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	128	0		29	10	S5617_128_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	128	0		29	10	S5617_128_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	133	0		29	10	S5617_133_0	5	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	5	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					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	133	0		29	10	S5617_133_0	5	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	133	0		29	10	S5617_133_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.73	43	43	43				68.52	43	43	43										43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	133	0		29	10	S5617_133_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	133	0		29	10	S5617_133_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	138	0		29	10	S5617_138_0	5	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	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, Select Care Drugs												
S5617	138	0		29	10	S5617_138_0	5	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					17.00	34.00	51.00											20.00	40.00	60.00				17.00	34.00	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												
S5617	138	0		29	10	S5617_138_0	5	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	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.02	41	41	41				60.80	41	41	41										41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	138	0		29	10	S5617_138_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	138	0		29	10	S5617_138_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	143	0		29	10	S5617_143_0	5	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	5	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					14.00	28.00	42.00											20.00	40.00	60.00				14.00	28.00	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												
S5617	143	0		29	10	S5617_143_0	5	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	143	0		29	10	S5617_143_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.57	45	45	45				73.84	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	143	0		29	10	S5617_143_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	143	0		29	10	S5617_143_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	148	0		29	10	S5617_148_0	5	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	5	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	5	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	148	0		29	10	S5617_148_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											94.20	50	50	50				77.49	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	148	0		29	10	S5617_148_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	148	0		29	10	S5617_148_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	153	0		29	10	S5617_153_0	5	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	5	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					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	153	0		29	10	S5617_153_0	5	Preferred Brand	3	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					30.00	60.00	90.00											37.00	74.00	111.00				30.00	60.00	90.00				37.00				37.00			1.23	1.00		1.23	1.00	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	153	0		29	10	S5617_153_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.40	44	44	44				73.23	44	44	44										44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	153	0		29	10	S5617_153_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	153	0		29	10	S5617_153_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	158	0		29	10	S5617_158_0	5	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					1.00	2.00	3.00											14.00	28.00	42.00				1.00	2.00	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, Select Care Drugs												
S5617	158	0		29	10	S5617_158_0	5	Generic	3	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					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	158	0		29	10	S5617_158_0	5	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								33.00	66.00	99.00					22.00	44.00	66.00											33.00	66.00	99.00				22.00	44.00	66.00				33.00				33.00			1.10	0.73		1.10	0.73	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	158	0		29	10	S5617_158_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											89.37	50	50	50				78.40	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	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	158	0		29	10	S5617_158_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
S5617	163	0		29	10	S5617_163_0	5	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	163	0		29	10	S5617_163_0	5	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					4.00	8.00	12.00											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, Select Care Drugs												
S5617	163	0		29	10	S5617_163_0	5	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	163	0		29	10	S5617_163_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											88.53	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	163	0		29	10	S5617_163_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	163	0		29	10	S5617_163_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	214	0		29	10	S5617_214_0	5	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					1.00	2.00	3.00											14.00	28.00	42.00				1.00	2.00	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, Select Care Drugs												
S5617	214	0		29	10	S5617_214_0	5	Generic	3	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					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	214	0		29	10	S5617_214_0	5	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	214	0		29	10	S5617_214_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											83.89	50	50	50				79.54	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	214	0		29	10	S5617_214_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	214	0		29	10	S5617_214_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	215	0		29	10	S5617_215_0	5	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					1.00	2.00	3.00											12.00	24.00	36.00				1.00	2.00	0.00				12.00				12.00			0.40	0.03		0.40	0.03	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	215	0		29	10	S5617_215_0	5	Generic	3	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					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	215	0		29	10	S5617_215_0	5	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	60.00				30.00				30.00			1.00	0.67		1.00	0.67	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	215	0		29	10	S5617_215_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											82.60	50	50	50				76.73	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	215	0		29	10	S5617_215_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	215	0		29	10	S5617_215_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
S5617	216	0		29	10	S5617_216_0	5	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	5	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	5	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	216	0		29	10	S5617_216_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											81.74	50	50	50				62.84	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	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	216	0		29	10	S5617_216_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	217	0		29	10	S5617_217_0	5	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	5	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	217	0		29	10	S5617_217_0	5	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	217	0		29	10	S5617_217_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											77.35	50	50	50				64.61	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	217	0		29	10	S5617_217_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	217	0		29	10	S5617_217_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S5617	218	0		29	10	S5617_218_0	5	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	5	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	5	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	218	0		29	10	S5617_218_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											88.36	50	50	50				66.81	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	218	0		29	10	S5617_218_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	218	0		29	10	S5617_218_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	219	0		29	10	S5617_219_0	5	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	5	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	5	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	219	0		29	10	S5617_219_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											87.29	50	50	50				65.05	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	219	0		29	10	S5617_219_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	219	0		29	10	S5617_219_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	220	0		29	10	S5617_220_0	5	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	5	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	5	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	220	0		29	10	S5617_220_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											93.98	50	50	50				72.85	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	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	220	0		29	10	S5617_220_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	221	0		29	10	S5617_221_0	5	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					1.00	2.00	3.00											14.00	28.00	42.00				1.00	2.00	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, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	5	Generic	3	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					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	5	Preferred Brand	3	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					28.00	56.00	84.00											40.00	80.00	120.00				28.00	56.00	84.00				40.00				40.00			1.33	0.93		1.33	0.93	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											93.27	50	50	50				79.25	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S5617	222	0		29	10	S5617_222_0	5	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					1.00	2.00	3.00											14.00	28.00	42.00				1.00	2.00	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, Select Care Drugs												
S5617	222	0		29	10	S5617_222_0	5	Generic	3	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					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	222	0		29	10	S5617_222_0	5	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								33.00	66.00	99.00					28.00	56.00	84.00											33.00	66.00	99.00				28.00	56.00	84.00				33.00				33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	222	0		29	10	S5617_222_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											97.33	50	50	50				79.75	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	222	0		29	10	S5617_222_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	222	0		29	10	S5617_222_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	223	0		29	10	S5617_223_0	5	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					1.00	2.00	3.00											14.00	28.00	42.00				1.00	2.00	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, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	5	Generic	3	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					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	0.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	5	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								36.00	72.00	108.00					29.00	58.00	87.00											36.00	72.00	108.00				29.00	58.00	87.00				36.00				36.00			1.20	0.97		1.20	0.97	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											84.03	50	50	50				77.16	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S5617	224	0		29	10	S5617_224_0	5	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	5	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	224	0		29	10	S5617_224_0	5	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	224	0		29	10	S5617_224_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											84.05	50	50	50				70.12	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	224	0		29	10	S5617_224_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	224	0		29	10	S5617_224_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	225	0		29	10	S5617_225_0	5	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	5	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	5	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	225	0		29	10	S5617_225_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											86.17	50	50	50				65.80	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	225	0		29	10	S5617_225_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	225	0		29	10	S5617_225_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	226	0		29	10	S5617_226_0	5	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	5	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	226	0		29	10	S5617_226_0	5	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	226	0		29	10	S5617_226_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											86.90	50	50	50				68.15	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	226	0		29	10	S5617_226_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	226	0		29	10	S5617_226_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	227	0		29	10	S5617_227_0	5	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					6.00	12.00	18.00											17.00	34.00	51.00				6.00	12.00	0.00				17.00				17.00			0.57	0.20		0.57	0.20	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	227	0		29	10	S5617_227_0	5	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					12.00	24.00	36.00											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, Select Care Drugs												
S5617	227	0		29	10	S5617_227_0	5	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								21.00	42.00	63.00					20.00	40.00	60.00											21.00	42.00	63.00				20.00	40.00	60.00				21.00				21.00			0.70	0.67		0.70	0.67	0.68	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	227	0		29	10	S5617_227_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											97.36	50	50	50				82.24	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	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	227	0		29	10	S5617_227_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	246	0		29	10	S5617_246_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											72.97	50	50	50				58.18	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	246	0		29	10	S5617_246_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											62.47	50	50	50				64.14	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											70.35	50	50	50				62.51	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											73.33	50	50	50				55.82	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											79.48	50	50	50				62.24	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											66.56	50	50	50				55.02	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	6	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	6	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	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	6	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	4.00				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	6	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											69.95	50	50	50				54.53	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	6	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											66.96	50	50	50				51.46	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											76.75	50	50	50				51.78	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	254	0		29	10	S5617_254_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											82.22	50	50	50				50.58	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											75.68	50	50	50				54.16	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											77.28	50	50	50				54.56	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	257	0		29	10	S5617_257_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											70.51	50	50	50				58.47	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											69.00	50	50	50				56.88	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											71.45	50	50	50				64.09	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	260	0		29	10	S5617_260_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											60.40	50	50	50				60.89	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	261	0		29	10	S5617_261_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											69.29	50	50	50				58.89	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	262	0		29	10	S5617_262_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											69.39	50	50	50				62.63	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											79.13	50	50	50				62.27	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	264	0		29	10	S5617_264_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											79.43	50	50	50				60.08	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											70.98	50	50	50				57.61	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	266	0		29	10	S5617_266_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											69.48	50	50	50				59.49	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	267	0		29	10	S5617_267_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											63.80	50	50	50				53.90	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											75.00	50	50	50				61.80	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	269	0		29	10	S5617_269_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											64.13	50	50	50				50.99	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											75.37	50	50	50				61.77	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	271	0		29	10	S5617_271_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											80.96	50	50	50				58.91	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	272	0		29	10	S5617_272_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											72.21	50	50	50				57.92	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											74.99	50	50	50				61.66	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											73.70	50	50	50				55.39	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	275	0		29	10	S5617_275_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											69.05	50	50	50				49.46	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											77.92	50	50	50				66.37	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	277	0		29	10	S5617_277_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											80.22	50	50	50				67.67	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	278	0		29	10	S5617_278_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	5	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	4.00				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	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											76.74	50	50	50				59.72	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	5	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	280	0		29	10	S5617_280_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											32.00	20	20	20				32.47	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											83.94	50	50	50				47.98	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	280	0		29	10	S5617_280_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	281	0		29	10	S5617_281_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	281	0		29	10	S5617_281_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											30.80	20	20	20				27.11	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											77.03	48	48	48				42.79	46	46	46										48	48	48				46	46	46			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	281	0		29	10	S5617_281_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	282	0		29	10	S5617_282_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	282	0		29	10	S5617_282_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											31.03	20	20	20				31.58	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											62.67	49	49	49				45.81	49	49	49										49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	282	0		29	10	S5617_282_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	283	0		29	10	S5617_283_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	283	0		29	10	S5617_283_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											30.67	20	20	20				31.23	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											68.46	50	50	50				45.06	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	283	0		29	10	S5617_283_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	284	0		29	10	S5617_284_0	5	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	284	0		29	10	S5617_284_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											26.75	20	20	20				28.81	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											57.40	43	43	43				37.22	43	43	43										43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	284	0		29	10	S5617_284_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	285	0		29	10	S5617_285_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	285	0		29	10	S5617_285_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											25.10	20	20	20				26.38	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											55.52	49	49	49				38.67	49	49	49										49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	285	0		29	10	S5617_285_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	286	0		29	10	S5617_286_0	6	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	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	286	0		29	10	S5617_286_0	6	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											26.79	20	20	20				25.86	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	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											78.85	50	50	50				47.50	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	286	0		29	10	S5617_286_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	287	0		29	10	S5617_287_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	287	0		29	10	S5617_287_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											29.62	20	20	20				29.04	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											71.50	50	50	50				44.82	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	287	0		29	10	S5617_287_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	288	0		29	10	S5617_288_0	5	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	288	0		29	10	S5617_288_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											25.64	20	20	20				25.27	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											64.83	50	50	50				44.55	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	288	0		29	10	S5617_288_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	289	0		29	10	S5617_289_0	5	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	289	0		29	10	S5617_289_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											28.12	20	20	20				27.77	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											66.88	50	50	50				37.86	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	289	0		29	10	S5617_289_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	290	0		29	10	S5617_290_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	290	0		29	10	S5617_290_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											28.49	20	20	20				27.02	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											82.30	50	50	50				50.05	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	290	0		29	10	S5617_290_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	291	0		29	10	S5617_291_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	291	0		29	10	S5617_291_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											29.96	20	20	20				25.26	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											67.93	50	50	50				37.78	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	291	0		29	10	S5617_291_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	292	0		29	10	S5617_292_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	292	0		29	10	S5617_292_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											27.94	20	20	20				25.55	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											63.81	47	47	47				39.06	47	47	47										47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	292	0		29	10	S5617_292_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	293	0		29	10	S5617_293_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	293	0		29	10	S5617_293_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											23.19	20	20	20				23.50	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											65.27	50	50	50				42.60	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	293	0		29	10	S5617_293_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	294	0		29	10	S5617_294_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	294	0		29	10	S5617_294_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											28.78	20	20	20				27.16	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	5	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				41.39	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	294	0		29	10	S5617_294_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	295	0		29	10	S5617_295_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	295	0		29	10	S5617_295_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											35.45	20	20	20				32.18	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											74.05	50	50	50				47.44	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	295	0		29	10	S5617_295_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	296	0		29	10	S5617_296_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	296	0		29	10	S5617_296_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											32.08	20	20	20				29.19	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											87.87	50	50	50				45.67	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	297	0		29	10	S5617_297_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	297	0		29	10	S5617_297_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											30.91	20	20	20				34.14	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											73.97	50	50	50				48.09	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	297	0		29	10	S5617_297_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	298	0		29	10	S5617_298_0	5	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	298	0		29	10	S5617_298_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											25.93	20	20	20				24.82	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											64.79	42	42	42				35.09	41	41	41										42	42	42				41	41	41			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	298	0		29	10	S5617_298_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	299	0		29	10	S5617_299_0	5	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	299	0		29	10	S5617_299_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											22.09	20	20	20				21.72	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											64.72	50	50	50				38.40	46	46	46										50	50	50				46	46	46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	299	0		29	10	S5617_299_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	300	0		29	10	S5617_300_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
S5617	300	0		29	10	S5617_300_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											22.86	19	19	19				21.03	18	18	18										19	19	19				18	18	18			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	300	0		29	10	S5617_300_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.08	41	41	41				28.41	40	40	40										41	41	41				40	40	40			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	300	0		29	10	S5617_300_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	301	0		29	10	S5617_301_0	5	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	301	0		29	10	S5617_301_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											33.04	20	20	20				29.89	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											68.05	50	50	50				41.89	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	301	0		29	10	S5617_301_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	302	0		29	10	S5617_302_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	302	0		29	10	S5617_302_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											26.04	20	20	20				30.88	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											64.00	50	50	50				41.60	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	302	0		29	10	S5617_302_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	303	0		29	10	S5617_303_0	5	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	303	0		29	10	S5617_303_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											32.67	20	20	20				30.37	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											86.37	50	50	50				44.84	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	304	0		29	10	S5617_304_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	304	0		29	10	S5617_304_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											33.97	20	20	20				32.01	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											73.48	50	50	50				42.01	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	305	0		29	10	S5617_305_0	5	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	305	0		29	10	S5617_305_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											29.36	20	20	20				29.23	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											89.58	49	49	49				48.73	47	47	47										49	49	49				47	47	47			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	305	0		29	10	S5617_305_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	306	0		29	10	S5617_306_0	5	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	306	0		29	10	S5617_306_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											31.53	20	20	20				29.44	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											88.42	48	48	48				51.12	47	47	47										48	48	48				47	47	47			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	306	0		29	10	S5617_306_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	307	0		29	10	S5617_307_0	5	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	307	0		29	10	S5617_307_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											26.22	20	20	20				26.60	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											80.98	50	50	50				43.50	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	307	0		29	10	S5617_307_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	308	0		29	10	S5617_308_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	308	0		29	10	S5617_308_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											29.03	20	20	20				31.48	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											80.47	50	50	50				51.16	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	308	0		29	10	S5617_308_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	309	0		29	10	S5617_309_0	5	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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	309	0		29	10	S5617_309_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											26.92	20	20	20				24.62	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											71.38	46	46	46				37.58	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	309	0		29	10	S5617_309_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	310	0		29	10	S5617_310_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	310	0		29	10	S5617_310_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											26.99	20	20	20				28.09	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											73.68	50	50	50				46.41	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	310	0		29	10	S5617_310_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	311	0		29	10	S5617_311_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	311	0		29	10	S5617_311_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											30.30	20	20	20				30.59	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											60.93	44	44	44				35.87	42	42	42										44	44	44				42	42	42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	311	0		29	10	S5617_311_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	312	0		29	10	S5617_312_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	312	0		29	10	S5617_312_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											38.14	20	20	20				45.93	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											81.47	43	43	43				48.71	43	43	43										43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	312	0		29	10	S5617_312_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	313	0		29	10	S5617_313_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	313	0		29	10	S5617_313_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											30.94	20	20	20				35.16	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											94.41	49	49	49				49.01	47	47	47										49	49	49				47	47	47			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	313	0		29	10	S5617_313_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	348	0		29	10	S5617_348_0	5	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	348	0		29	10	S5617_348_0	5	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	348	0		29	10	S5617_348_0	5	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					39.00	78.00	117.00											47.00	94.00	141.00				39.00	78.00	117.00				47.00				47.00			1.57	1.30		1.57	1.30	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	348	0		29	10	S5617_348_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											72.95	50	50	50				68.96	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	348	0		29	10	S5617_348_0	5	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	348	0		29	10	S5617_348_0	5	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	349	0		29	10	S5617_349_0	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	349	0		29	10	S5617_349_0	5	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	349	0		29	10	S5617_349_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	4.00				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	349	0		29	10	S5617_349_0	5	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	4.00				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	349	0		29	10	S5617_349_0	5	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	349	0		29	10	S5617_349_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											71.77	50	50	50				61.40	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	349	0		29	10	S5617_349_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	349	0		29	10	S5617_349_0	5	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					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	350	0		29	10	S5617_350_0	5	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	350	0		29	10	S5617_350_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	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												
S5617	350	0		29	10	S5617_350_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											28.06	20	20	20				27.73	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	350	0		29	10	S5617_350_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											74.99	50	50	50				47.75	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	350	0		29	10	S5617_350_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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												
S5715	001	0		29	10	S5715_001_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	001	0		29	10	S5715_001_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		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												
S5715	001	0		29	10	S5715_001_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		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												
S5715	001	0		29	10	S5715_001_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											96.08	45		45				98.23	41		41										45		45				41		41			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	001	0		29	10	S5715_001_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												
S5715	003	0		29	10	S5715_003_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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												
S5715	003	0		29	10	S5715_003_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	003	0		29	10	S5715_003_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		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												
S5715	003	0		29	10	S5715_003_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					45.00		135.00											47.00		141.00				45.00		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												
S5715	003	0		29	10	S5715_003_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.97	45		45				97.88	42		42										45		45				42		42			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					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												
S5715	004	0		29	10	S5715_004_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					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		
S5715	004	0		29	10	S5715_004_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					2.00		6.00											9.00		27.00				2.00		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												
S5715	004	0		29	10	S5715_004_0	3	Preferred Brand	4	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		90.00				37.00				37.00			1.23	1.00		1.23	1.00	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											73.73	45		45				81.77	40		40										45		45				40		40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	3	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	1	2				30		90	30		31												33		33					33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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												
S5715	005	0		29	10	S5715_005_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	005	0		29	10	S5715_005_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		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												
S5715	005	0		29	10	S5715_005_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		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												
S5715	005	0		29	10	S5715_005_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.08	42		42				91.56	38		38										42		42				38		38			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					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												
S5715	006	0		29	10	S5715_006_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					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		
S5715	006	0		29	10	S5715_006_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					2.00		6.00											9.00		27.00				2.00		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												
S5715	006	0		29	10	S5715_006_0	3	Preferred Brand	4	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		90.00				37.00				37.00			1.23	1.00		1.23	1.00	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											83.91	45		45				74.16	40		40										45		45				40		40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	3	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	1	2				30		90	30		31												33		33					33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	3	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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												
S5715	010	0		29	10	S5715_010_0	3	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	010	0		29	10	S5715_010_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		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												
S5715	010	0		29	10	S5715_010_0	3	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		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												
S5715	010	0		29	10	S5715_010_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.31	44		44				94.41	40		40										44		44				40		40			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	010	0		29	10	S5715_010_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												
S5715	012	0		29	10	S5715_012_0	4	Preferred Generic	2	01	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		3.00				8.00				8.00			0.27	0.03		0.27	0.03	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	4	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					4.00		12.00											11.00		33.00				4.00		12.00				11.00				11.00			0.37	0.13		0.37	0.13	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	4	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								30.00		90.00					23.00		69.00											30.00		90.00				23.00		69.00				30.00				30.00			1.00	0.77		1.00	0.77	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.92	38		38				51.53	36		36										38		38				36		36			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	4	Preferred Generic	2	01	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		3.00				8.00				8.00			0.27	0.03		0.27	0.03	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	4	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					4.00		12.00											11.00		33.00				4.00		12.00				11.00				11.00			0.37	0.13		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	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								27.00		81.00					20.00		60.00											27.00		81.00				20.00		60.00				27.00				27.00			0.90	0.67		0.90	0.67	0.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											56.73	34		34				47.92	32		32										34		34				32		32			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	4	Preferred Generic	2	01	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		3.00				8.00				8.00			0.27	0.03		0.27	0.03	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	4	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					4.00		12.00											11.00		33.00				4.00		12.00				11.00				11.00			0.37	0.13		0.37	0.13	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	4	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								27.00		81.00					20.00		60.00											27.00		81.00				20.00		60.00				27.00				27.00			0.90	0.67		0.90	0.67	0.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											54.11	33		33				46.17	31		31										33		33				31		31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	4	Preferred Generic	2	01	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		3.00				8.00				8.00			0.27	0.03		0.27	0.03	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	4	Generic	2	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					4.00		12.00											11.00		33.00				4.00		12.00				11.00				11.00			0.37	0.13		0.37	0.13	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	4	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								27.00		81.00					20.00		60.00											27.00		81.00				20.00		60.00				27.00				27.00			0.90	0.67		0.90	0.67	0.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											39.95	29		29				34.01	27		27										29		29				27		27			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	018	0		29	10	S5715_018_0	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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												
S5715	018	0		29	10	S5715_018_0	4	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		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												
S5715	018	0		29	10	S5715_018_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					44.00		132.00											47.00		141.00				44.00		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												
S5715	018	0		29	10	S5715_018_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.01	50		50				87.66	45		45										50		50				45		45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	018	0		29	10	S5715_018_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												
S5715	019	0		29	10	S5715_019_0	4	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	019	0		29	10	S5715_019_0	4	Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		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												
S5715	019	0		29	10	S5715_019_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					44.00		132.00											47.00		141.00				44.00		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												
S5715	019	0		29	10	S5715_019_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.42	43		43				83.23	38		38										43		43				38		38			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	019	0		29	10	S5715_019_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												
S5726	013	0		29	10	S5726_013_0	6	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	3.00																5.00				5.00			0.17	0.03	0.03			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	6	Generic	3	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	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	6	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					36.00	72.00	108.00					36.00	72.00	108.00																36.00				36.00			1.20	1.20	1.20			1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	6	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											88.28	37	37	37				88.28	37	37	37				37	37	37															37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	6	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	6	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	6	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	6	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											65.31	50	50	50				65.31	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	2	Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	14.00					1.00	2.00	2.00											7.00	14.00	14.00				1.00	2.00	2.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	2	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	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												
S5743	001	0		29	10	S5743_001_0	2	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	2	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.15	40	40	40				76.58	35	35	35										40	40	40				35	35	35			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											1457.04	25						1406.60	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	2	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	30.00					0.00	0.00	0.00											15.00	30.00	30.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	2	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	30.00					0.00	0.00	0.00											15.00	30.00	30.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5743	004	0		29	10	S5743_004_0	2	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	40.00					0.00	0.00	0.00											20.00	40.00	40.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	2	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	40.00					0.00	0.00	0.00											20.00	40.00	40.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5743	004	0		29	10	S5743_004_0	2	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											27.58	25	25	25				17.87	17	17	17										25	25	25				17	17	17			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.14	45	45	45				66.97	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	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1661.37	33						1641.21	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	4	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	4	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	4	Preferred Brand	2	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	117.50				42.00	84.00	105.00					47.00			42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											92.31	50	50	50				90.47	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	4	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				29	31											847.33	25						847.33	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00					5.00			0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00					5.00			0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5753	007	0		29	10	S5753_007_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								16.00	32.00	48.00					11.00	22.00	33.00											16.00	32.00	40.00				11.00	22.00	27.50					16.00			11.00			0.53	0.37		0.53	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								16.00	32.00	48.00					11.00	22.00	33.00											16.00	32.00	40.00				11.00	22.00	27.50					16.00			11.00			0.53	0.37		0.53	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5753	007	0		29	10	S5753_007_0	4	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	117.50				42.00	84.00	105.00					47.00			42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											78.02	50	50	50				70.21	45	45	45										50	50	50				45	45	45				50		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	4	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				29	31											1297.16	33						1297.16	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	2	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		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												
S5795	002	0		29	10	S5795_002_0	2	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		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										1		
S5795	002	0		29	10	S5795_002_0	2	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				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												
S5795	002	0		29	10	S5795_002_0	2	Generic	4	01	1	2	2	3	110		01	110		1	30		100				1	2	30		100				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										1		
S5795	002	0		29	10	S5795_002_0	2	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												
S5795	002	0		29	10	S5795_002_0	2	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												
S5795	002	0		29	10	S5795_002_0	2	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	2	Preferred Generic	3	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				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												
S5795	003	0		29	10	S5795_003_0	2	Generic	3	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				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												
S5795	003	0		29	10	S5795_003_0	2	Preferred Brand	3	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				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												
S5795	003	0		29	10	S5795_003_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				65.80	47		47																		47		47															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	2	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	008	0		29	10	S5795_008_0	2	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				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												
S5795	008	0		29	10	S5795_008_0	2	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				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												
S5795	008	0		29	10	S5795_008_0	2	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												
S5795	008	0		29	10	S5795_008_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				79.30	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	008	0		29	10	S5795_008_0	2	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					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	3	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	3	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	3	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	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	45		45				66.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											502.00	33						406.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	45		45				55.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											392.00	33						289.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					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	2	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	2	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	2	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	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	45		45				62.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											375.00	33						433.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	2	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	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	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	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	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	003	0		29	10	S5820_003_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											420.00	33						262.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	45		45				62.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											448.00	33						281.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											68.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											461.00	33						420.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											66.00	45		45				55.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											438.00	33						357.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	45		45				55.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											487.00	33						409.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	45		45				58.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											488.00	33						391.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	45		45				62.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											510.00	33						452.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	45		45				65.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											477.00	33						434.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	45		45				59.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											501.00	33						408.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											459.00	33						440.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											67.00	45		45				58.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											505.00	33						470.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	45		45				56.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											483.00	33						443.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	45		45				57.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											534.00	33						404.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	45		45				61.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											505.00	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	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	45		45				57.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											506.00	33						502.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	45		45				52.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											535.00	33						458.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											557.00	33						401.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											80.00	45		45				60.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											500.00	33						473.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	2	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	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	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	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	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	021	0		29	10	S5820_021_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											382.00	33						399.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				56.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											541.00	33						366.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	45		45				58.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											537.00	33						468.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	45		45				59.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											552.00	33						449.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					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	2	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	2	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	2	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	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	45		45				59.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											514.00	33						630.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											77.00	45		45				64.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											530.00	33						332.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	45		45				63.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											520.00	33						430.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	45		45				64.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											557.00	33						305.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	2	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	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	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	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	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	029	0		29	10	S5820_029_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											430.00	33						295.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					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	2	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	2	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	2	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	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	45		45				58.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											494.00	33						497.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	45		45				65.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											483.00	33						431.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	45		45				74.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											523.00	33						438.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	2	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	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	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	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	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											65.00	45		45				63.00	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											366.00	33						358.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2	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	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	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				61.00	42		42																				42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				232.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2	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	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	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				58.00	40		40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				334.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	3	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	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	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				68.00	43		43																				43															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	3	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				310.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2	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	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	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												
S5820	037	0		29	10	S5820_037_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											68.00	50		50				55.00	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	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											443.00	25						288.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	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	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	Preferred Brand	2	11	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		1.46						1.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				72.00	44		44																				44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				213.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	5	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	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	Preferred Brand	2	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		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	5	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	41		41				69.00	35		35										41		41				35		30			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	5	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	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		15			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											85.00	41		41				83.00	40		40										41		41				40		30			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											43.00	24		24				34.00	19		19										24		24				19		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											89.00	41		41				83.00	38		38										41		41				38		30			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	23		23				33.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											89.00	43		43				83.00	40		40										43		43				40		30			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	25		25				30.00	19		19										25		25				19		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											86.00	49		49				71.00	40		40										49		49				40		30			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	24		24				29.00	19		19										24		24				19		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											86.00	43		43				78.00	39		39										43		43				39		30			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	23		23				33.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											87.00	45		45				77.00	40		40										45		45				40		30			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	5	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	5	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	5	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	23		23				32.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	5	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											95.00	40		40				90.00	38		38										40		40				38		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	5	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	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		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	4	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				75.00	38		38										42		42				38		30			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	4	Preferred Generic	2	11	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.00	17		17				0.00	7		7										17		17				7		0			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	4	Generic	2	11	1	1	2	1		110	01		110	1				30		90	2	2				30		90	30		31											2.00	19		19				1.00	11		11										19		19				11		0			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	4	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	110	0		29	10	S5884_110_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	39		39				73.00	35		35										39		39				35		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											42.00	24		24				33.00	19		19										24		24				19		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											86.00	38		38				81.00	36		36										38		38				36		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	4	Preferred Generic	2	11	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.00	17		17				0.00	7		7										17		17				7		0			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	4	Generic	2	11	1	1	2	1		110	01		110	1				30		90	2	2				30		90	30		31											2.00	22		22				1.00	11		11										22		22				11		0			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											43.00	24		24				36.00	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	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											87.00	38		38				80.00	35		35										38		38				35		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	23		23				31.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											91.00	45		45				75.00	37		37										45		45				37		30			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											42.00	21		21				38.00	19		19										21		21				19		15			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											97.00	42		42				83.00	36		36										42		42				36		30			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											45.00	25		25				38.00	21		21										25		25				21		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											87.00	50		50				85.00	49		49										50		50				49		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											44.00	24		24				35.00	19		19										24		24				19		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											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	116	0		29	10	S5884_116_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	21		21				35.00	19		19										21		21				19		15			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											96.00	44		44				87.00	40		40										44		44				40		30			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	5	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	5	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	5	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	23		23				33.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	5	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											93.00	43		43				86.00	40		40										43		43				40		30			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	5	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	23		23				33.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											98.00	40		40				89.00	36		36										40		40				36		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											36.00	25		25				35.00	24		24										25		25				24		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	4	Non-Preferred Drug	2	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		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	4	Preferred Generic	2	11	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.00	17		17				0.00	7		7										17		17				7		0			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	4	Generic	2	11	1	1	2	1		110	01		110	1				30		90	2	2				30		90	30		31											2.00	19		19				1.00	11		11										19		19				11		0			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	25		25				32.00	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	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	38		38				76.00	35		35										38		38				35		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	23		23				31.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											87.00	40		40				84.00	39		39										40		40				39		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	25		25				31.00	21		21										25		25				21		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											88.00	50		50				86.00	49		49										50		50				49		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	23		23				32.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											95.00	44		44				88.00	41		41										44		44				41		30			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	23		23				32.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											88.00	41		41				83.00	39		39										41		41				39		30			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	24		24				29.00	19		19										24		24				19		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											86.00	38		38				81.00	36		36										38		38				36		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											35.00	24		24				28.00	19		19										24		24				19		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	47		47				88.00	45		45										47		47				45		30			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											43.00	24		24				34.00	19		19										24		24				19		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											84.00	39		39				82.00	38		38										39		39				38		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	23		23				33.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											99.00	46		46				92.00	43		43										46		46				43		30			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	23		23				33.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											98.00	41		41				96.00	40		40										41		41				40		30			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											36.00	23		23				29.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											77.00	39		39				73.00	37		37										39		39				37		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											44.00	24		24				34.00	19		19										24		24				19		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											94.00	41		41				90.00	39		39										41		41				39		30			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	4	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					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	4	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	4	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											36.00	24		24				28.00	19		19										24		24				19		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											87.00	37		37				82.00	35		35										37		37				35		30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	6	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	6	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	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	6	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				86.00	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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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	149	0		29	10	S5884_149_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											98.00	50		50				96.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											99.00	49		49				97.00	48		48										49		49				48		48			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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	152	0		29	10	S5884_152_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				86.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				90.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				95.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				91.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				91.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				89.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				89.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				91.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				88.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											86.00	50		50				85.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				88.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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	164	0		29	10	S5884_164_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				90.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				86.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				94.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											98.00	50		50				96.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											96.00	50		50				94.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											85.00	50		50				83.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											84.00	50		50				83.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				90.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											98.00	50		50				96.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				92.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											98.00	46		46				96.00	45		45										46		46				45		45			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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				85.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	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	177	0		29	10	S5884_177_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											100.00	50		50				98.00	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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											98.00	41		41				96.00	40		40										41		41				40		40			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											99.00	47		47				97.00	46		46										47		47				46		46			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	181	0		29	10	S5884_181_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	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	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	16		16				31.00	15		15										16		16				15		15			16			16								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	181	0		29	10	S5884_181_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											91.00	47		47				78.00	40		40										47		47				40		40			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	181	0		29	10	S5884_181_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	182	0		29	10	S5884_182_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	182	0		29	10	S5884_182_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	18		18				30.00	16		16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	182	0		29	10	S5884_182_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	48		48				70.00	41		41										48		48				41		41			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	182	0		29	10	S5884_182_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	183	0		29	10	S5884_183_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	17		17				28.00	14		14										17		17				14		14			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	183	0		29	10	S5884_183_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											90.00	49		49				73.00	40		40										49		49				40		40			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	183	0		29	10	S5884_183_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	184	0		29	10	S5884_184_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	16		16				28.00	15		15										16		16				15		15			16			16								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	184	0		29	10	S5884_184_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	47		47				72.00	41		41										47		47				41		41			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	184	0		29	10	S5884_184_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	185	0		29	10	S5884_185_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	185	0		29	10	S5884_185_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	18		18				30.00	16		16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	185	0		29	10	S5884_185_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	48		48				72.00	42		42										48		48				42		42			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	185	0		29	10	S5884_185_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	186	0		29	10	S5884_186_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	19		19				36.00	18		18										19		19				18		18			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	186	0		29	10	S5884_186_0	4	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				71.00	41		41										50		50				41		41			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	186	0		29	10	S5884_186_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	187	0		29	10	S5884_187_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	187	0		29	10	S5884_187_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		7.00				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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	18		18				27.00	15		15										18		18				15		15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	187	0		29	10	S5884_187_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											96.00	50		50				86.00	45		45										50		50				45		45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	187	0		29	10	S5884_187_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	188	0		29	10	S5884_188_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	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	188	0		29	10	S5884_188_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											95.00	48		48				73.00	37		37										48		48				37		37			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	188	0		29	10	S5884_188_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	189	0		29	10	S5884_189_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	21		21				28.00	16		16										21		21				16		16			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	189	0		29	10	S5884_189_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											98.00	45		45				83.00	38		38										45		45				38		38			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	189	0		29	10	S5884_189_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	190	0		29	10	S5884_190_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	22		22				25.00	15		15										22		22				15		15			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	190	0		29	10	S5884_190_0	4	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				75.00	42		42										50		50				42		42			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	190	0		29	10	S5884_190_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	191	0		29	10	S5884_191_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	22		22				29.00	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											87.00	48		48				72.00	40		40										48		48				40		40			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	191	0		29	10	S5884_191_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	192	0		29	10	S5884_192_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	20		20				31.00	16		16										20		20				16		16			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	192	0		29	10	S5884_192_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											91.00	49		49				82.00	44		44										49		49				44		44			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	192	0		29	10	S5884_192_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	193	0		29	10	S5884_193_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											43.00	21		21				37.00	18		18										21		21				18		18			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	193	0		29	10	S5884_193_0	4	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				77.00	42		42										50		50				42		42			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	193	0		29	10	S5884_193_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	194	0		29	10	S5884_194_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	20		20				34.00	18		18										20		20				18		18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	194	0		29	10	S5884_194_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											85.00	46		46				70.00	38		38										46		46				38		38			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	194	0		29	10	S5884_194_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	195	0		29	10	S5884_195_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											44.00	20		20				39.00	18		18										20		20				18		18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	195	0		29	10	S5884_195_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											79.00	49		49				62.00	38		38										49		49				38		38			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	195	0		29	10	S5884_195_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	196	0		29	10	S5884_196_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											45.00	21		21				34.00	16		16										21		21				16		16			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	196	0		29	10	S5884_196_0	4	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				79.00	42		42										50		50				42		42			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	196	0		29	10	S5884_196_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	197	0		29	10	S5884_197_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											42.00	20		20				33.00	16		16										20		20				16		16			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	197	0		29	10	S5884_197_0	4	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				79.00	43		43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	197	0		29	10	S5884_197_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	198	0		29	10	S5884_198_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	198	0		29	10	S5884_198_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											36.00	19		19				32.00	17		17										19		19				17		17			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	198	0		29	10	S5884_198_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											95.00	48		48				85.00	43		43										48		48				43		43			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	198	0		29	10	S5884_198_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	199	0		29	10	S5884_199_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											42.00	21		21				32.00	16		16										21		21				16		16			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	199	0		29	10	S5884_199_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											77.00	43		43				66.00	37		37										43		43				37		37			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	199	0		29	10	S5884_199_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	200	0		29	10	S5884_200_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	200	0		29	10	S5884_200_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		6.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	200	0		29	10	S5884_200_0	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	18		18				24.00	15		15										18		18				15		15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	200	0		29	10	S5884_200_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	47		47				73.00	46		46										47		47				46		46			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	200	0		29	10	S5884_200_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	201	0		29	10	S5884_201_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	20		20				31.00	16		16										20		20				16		16			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	201	0		29	10	S5884_201_0	4	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				77.00	41		41										49		49				41		41			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	201	0		29	10	S5884_201_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	202	0		29	10	S5884_202_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	16		16				29.00	15		15										16		16				15		15			16			16								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	202	0		29	10	S5884_202_0	4	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				74.00	38		38										48		48				38		38			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	202	0		29	10	S5884_202_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	203	0		29	10	S5884_203_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	203	0		29	10	S5884_203_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		6.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	203	0		29	10	S5884_203_0	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	19		19				35.00	17		17										19		19				17		17			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	203	0		29	10	S5884_203_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											86.00	50		50				73.00	42		42										50		50				42		42			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	203	0		29	10	S5884_203_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	204	0		29	10	S5884_204_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	204	0		29	10	S5884_204_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											41.00	19		19				35.00	16		16										19		19				16		16			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	204	0		29	10	S5884_204_0	4	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				86.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	204	0		29	10	S5884_204_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	205	0		29	10	S5884_205_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	18		18				36.00	17		17										18		18				17		17			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	205	0		29	10	S5884_205_0	4	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				69.00	39		39										50		50				39		39			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	205	0		29	10	S5884_205_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		5.00				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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	20		20				32.00	16		16										20		20				16		16			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	46		46				74.00	41		41										46		46				41		41			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	207	0		29	10	S5884_207_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	19		19				37.00	18		18										19		19				18		18			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	207	0		29	10	S5884_207_0	4	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				73.00	41		41										50		50				41		41			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	207	0		29	10	S5884_207_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	208	0		29	10	S5884_208_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	16		16				28.00	15		15										16		16				15		15			16			16								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	208	0		29	10	S5884_208_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											95.00	45		45				74.00	35		35										45		45				35		35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	208	0		29	10	S5884_208_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	209	0		29	10	S5884_209_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	209	0		29	10	S5884_209_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		6.00				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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	21		21				28.00	16		16										21		21				16		16			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	209	0		29	10	S5884_209_0	4	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				73.00	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	209	0		29	10	S5884_209_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	210	0		29	10	S5884_210_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	17		17				30.00	16		16										17		17				16		16			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	210	0		29	10	S5884_210_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	48		48				71.00	41		41										48		48				41		41			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	210	0		29	10	S5884_210_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	211	0		29	10	S5884_211_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	211	0		29	10	S5884_211_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		6.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	211	0		29	10	S5884_211_0	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	19		19				27.00	15		15										19		19				15		15			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	211	0		29	10	S5884_211_0	4	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				76.00	40		40										50		50				40		40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	211	0		29	10	S5884_211_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	212	0		29	10	S5884_212_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	18		18				36.00	16		16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	212	0		29	10	S5884_212_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	46		46				76.00	38		38										46		46				38		38			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	212	0		29	10	S5884_212_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	213	0		29	10	S5884_213_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		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	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											41.00	18		18				36.00	16		16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	213	0		29	10	S5884_213_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	40		40				90.00	39		39										40		40				39		39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	213	0		29	10	S5884_213_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	5	Preferred Generic	3	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												
S5904	001	0		29	10	S5904_001_0	5	Generic	3	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	13.00		39.00																			13.00		39.00																13.00				13.00		0.42			0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	5	Preferred Brand	3	10	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			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	5	Non-Preferred Drug	3	10	1	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				99.74	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	5	Specialty Tier	3	10	1	1	5	1	010		01	010		1	31								31						31		31				1231.22	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	3	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	3	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	3	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	3	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	3	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	3	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	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1564.46	33						1564.46	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	2	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	2	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	2	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	2	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											77.68	45	45	45				69.05	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	2	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											939.22	26						939.22	26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	3	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	3	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	3	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	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	3	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				69.05	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	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1192.09	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	3	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	348	0		29	10	S5921_348_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											63.00	40		40				60.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											283.00	25						325.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	3	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	3	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	349	0		29	10	S5921_349_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	40		40				67.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											275.00	25						263.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								14.00		42.00					9.00		27.00													42.00						27.00				14.00				14.00			0.46	0.30				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											66.00	40		40				59.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											290.00	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	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	3	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	351	0		29	10	S5921_351_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											62.00	40		40				62.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											294.00	25						285.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	4	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	4	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	4	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								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	352	0		29	10	S5921_352_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											64.00	40		40				61.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											293.00	25						295.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.46				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	40		40				57.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											293.00	25						302.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								19.00		57.00					14.00		42.00													57.00						42.00				19.00				19.00			0.63	0.46				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											65.00	40		40				57.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											315.00	25						260.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	3	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	355	0		29	10	S5921_355_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	40		40				62.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											317.00	25						329.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								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	356	0		29	10	S5921_356_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											68.00	40		40				64.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											219.00	25						215.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	3	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	357	0		29	10	S5921_357_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											66.00	40		40				63.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											296.00	25						317.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	3	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	358	0		29	10	S5921_358_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	40		40				61.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											278.00	25						299.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					19.00		57.00													60.00						57.00				20.00				20.00			0.66	0.63				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					46.00		138.00													141.00						138.00				47.00				47.00			1.56	1.53				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											65.00	40		40				56.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											299.00	25						217.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	3	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	360	0		29	10	S5921_360_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											66.00	40		40				65.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											269.00	25						223.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	4	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	4	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	4	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	361	0		29	10	S5921_361_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											66.00	40		40				56.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											308.00	25						241.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								14.00		42.00					9.00		27.00													42.00						27.00				14.00				14.00			0.46	0.30				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	3	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	362	0		29	10	S5921_362_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											63.00	40		40				63.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											264.00	25						266.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	3	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	363	0		29	10	S5921_363_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											60.00	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	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											286.00	25						230.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								14.00		42.00					9.00		27.00													42.00						27.00				14.00				14.00			0.46	0.30				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	40		40				53.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											320.00	25						236.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	3	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	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											68.00	40		40				62.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											245.00	25						247.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	4	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	4	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	4	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								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	366	0		29	10	S5921_366_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											76.00	40		40				69.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											297.00	25						296.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	3	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	367	0		29	10	S5921_367_0	3	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	367	0		29	10	S5921_367_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											68.00	40		40				62.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											297.00	25						194.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								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	368	0		29	10	S5921_368_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	40		40				66.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											293.00	25						319.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	3	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	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											65.00	40		40				57.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											177.00	25						161.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	4	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	4	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	4	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	370	0		29	10	S5921_370_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											60.00	40		40				59.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											297.00	25						262.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	3	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	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	371	0		29	10	S5921_371_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											59.00	40		40				60.00	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	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											288.00	25						156.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					15.00		45.00													60.00						45.00				20.00				20.00			0.66	0.50				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					46.00		138.00													141.00						138.00				47.00				47.00			1.56	1.53				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	40		40				62.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											305.00	25						245.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	3	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	373	0		29	10	S5921_373_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											67.00	40		40				66.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											235.00	25						275.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	3	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	3	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	374	0		29	10	S5921_374_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											62.00	40		40				60.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											291.00	25						272.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	3	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	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	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	375	0		29	10	S5921_375_0	3	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	375	0		29	10	S5921_375_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											353.00	25						395.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	3	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	376	0		29	10	S5921_376_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	40		40				63.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											283.00	25						306.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								18.00		54.00					13.00		39.00													54.00						39.00				18.00				18.00			0.60	0.43				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											59.00	40		40				63.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											187.00	25						343.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											63.00	40		40				53.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											215.00	25						221.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	3	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	379	0		29	10	S5921_379_0	3	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	379	0		29	10	S5921_379_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											296.00	25						180.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	4	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	4	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					15.00		45.00													60.00						45.00				20.00				20.00			0.66	0.50				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	4	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					42.00		126.00													141.00						126.00				47.00				47.00			1.56	1.40				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	40		40				63.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											290.00	25						252.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	3	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	381	0		29	10	S5921_381_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											78.00	38		38				96.00	38		38												38						38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											258.00	25						118.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	382	0		29	10	S5921_382_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	382	0		29	10	S5921_382_0	3	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	382	0		29	10	S5921_382_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											320.00	27						215.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	383	0		29	10	S5921_383_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	383	0		29	10	S5921_383_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											81.00	45		45				68.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											301.00	27						235.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	384	0		29	10	S5921_384_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	384	0		29	10	S5921_384_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	384	0		29	10	S5921_384_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	384	0		29	10	S5921_384_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	384	0		29	10	S5921_384_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											93.00	45		45				65.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	384	0		29	10	S5921_384_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											406.00	27						222.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	385	0		29	10	S5921_385_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	385	0		29	10	S5921_385_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	385	0		29	10	S5921_385_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	385	0		29	10	S5921_385_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	385	0		29	10	S5921_385_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	45		45				60.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	385	0		29	10	S5921_385_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											225.00	27						219.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	386	0		29	10	S5921_386_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	386	0		29	10	S5921_386_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	386	0		29	10	S5921_386_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	386	0		29	10	S5921_386_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	386	0		29	10	S5921_386_0	3	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	386	0		29	10	S5921_386_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											220.00	27						170.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	387	0		29	10	S5921_387_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	387	0		29	10	S5921_387_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	387	0		29	10	S5921_387_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	387	0		29	10	S5921_387_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	387	0		29	10	S5921_387_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											66.00	45		45				63.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	387	0		29	10	S5921_387_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											290.00	27						209.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	388	0		29	10	S5921_388_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	388	0		29	10	S5921_388_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	388	0		29	10	S5921_388_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	388	0		29	10	S5921_388_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	388	0		29	10	S5921_388_0	3	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												
S5921	388	0		29	10	S5921_388_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											287.00	27						269.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	389	0		29	10	S5921_389_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	389	0		29	10	S5921_389_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	389	0		29	10	S5921_389_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	389	0		29	10	S5921_389_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	389	0		29	10	S5921_389_0	3	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	389	0		29	10	S5921_389_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											208.00	27						329.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	390	0		29	10	S5921_390_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	390	0		29	10	S5921_390_0	3	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												
S5921	390	0		29	10	S5921_390_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											208.00	27						278.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	391	0		29	10	S5921_391_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	391	0		29	10	S5921_391_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	391	0		29	10	S5921_391_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	391	0		29	10	S5921_391_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	391	0		29	10	S5921_391_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											82.00	45		45				67.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	391	0		29	10	S5921_391_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											378.00	27						337.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	392	0		29	10	S5921_392_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	392	0		29	10	S5921_392_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	392	0		29	10	S5921_392_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	392	0		29	10	S5921_392_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	392	0		29	10	S5921_392_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	45		45				70.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	392	0		29	10	S5921_392_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											339.00	27						247.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	393	0		29	10	S5921_393_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	393	0		29	10	S5921_393_0	3	Generic	4	01	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	393	0		29	10	S5921_393_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	393	0		29	10	S5921_393_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	393	0		29	10	S5921_393_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											83.00	45		45				68.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	393	0		29	10	S5921_393_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											292.00	27						278.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	394	0		29	10	S5921_394_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	394	0		29	10	S5921_394_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	394	0		29	10	S5921_394_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	394	0		29	10	S5921_394_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	394	0		29	10	S5921_394_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											82.00	45		45				60.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	394	0		29	10	S5921_394_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											298.00	27						257.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	395	0		29	10	S5921_395_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	395	0		29	10	S5921_395_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	395	0		29	10	S5921_395_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	395	0		29	10	S5921_395_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	395	0		29	10	S5921_395_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	45		45				65.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	395	0		29	10	S5921_395_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											243.00	27						215.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	396	0		29	10	S5921_396_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	396	0		29	10	S5921_396_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	396	0		29	10	S5921_396_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	396	0		29	10	S5921_396_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	396	0		29	10	S5921_396_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											76.00	45		45				65.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	396	0		29	10	S5921_396_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											291.00	27						199.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	397	0		29	10	S5921_397_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	397	0		29	10	S5921_397_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	397	0		29	10	S5921_397_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	397	0		29	10	S5921_397_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	397	0		29	10	S5921_397_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	45		45				60.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	397	0		29	10	S5921_397_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											161.00	27						274.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	398	0		29	10	S5921_398_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	398	0		29	10	S5921_398_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	398	0		29	10	S5921_398_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	398	0		29	10	S5921_398_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	398	0		29	10	S5921_398_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				65.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	398	0		29	10	S5921_398_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											270.00	27						273.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	399	0		29	10	S5921_399_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	399	0		29	10	S5921_399_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	399	0		29	10	S5921_399_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	399	0		29	10	S5921_399_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	399	0		29	10	S5921_399_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	45		45				61.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	399	0		29	10	S5921_399_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											329.00	27						238.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	400	0		29	10	S5921_400_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	400	0		29	10	S5921_400_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	400	0		29	10	S5921_400_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	400	0		29	10	S5921_400_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	400	0		29	10	S5921_400_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	45		45				60.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	400	0		29	10	S5921_400_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											269.00	27						265.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	401	0		29	10	S5921_401_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	401	0		29	10	S5921_401_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	401	0		29	10	S5921_401_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	401	0		29	10	S5921_401_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	401	0		29	10	S5921_401_0	3	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												
S5921	401	0		29	10	S5921_401_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											368.00	27						222.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	402	0		29	10	S5921_402_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	402	0		29	10	S5921_402_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	402	0		29	10	S5921_402_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	402	0		29	10	S5921_402_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	402	0		29	10	S5921_402_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				70.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	402	0		29	10	S5921_402_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											402.00	27						229.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	403	0		29	10	S5921_403_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	403	0		29	10	S5921_403_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	403	0		29	10	S5921_403_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	403	0		29	10	S5921_403_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	403	0		29	10	S5921_403_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											88.00	45		45				66.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	403	0		29	10	S5921_403_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											267.00	27						205.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	404	0		29	10	S5921_404_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	404	0		29	10	S5921_404_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	404	0		29	10	S5921_404_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	404	0		29	10	S5921_404_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	404	0		29	10	S5921_404_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											89.00	45		45				68.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	404	0		29	10	S5921_404_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											387.00	27						362.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	405	0		29	10	S5921_405_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	405	0		29	10	S5921_405_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	405	0		29	10	S5921_405_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	405	0		29	10	S5921_405_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	405	0		29	10	S5921_405_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											81.00	45		45				64.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	405	0		29	10	S5921_405_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											366.00	27						227.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	406	0		29	10	S5921_406_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	406	0		29	10	S5921_406_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	406	0		29	10	S5921_406_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	406	0		29	10	S5921_406_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	406	0		29	10	S5921_406_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											78.00	45		45				60.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	406	0		29	10	S5921_406_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											192.00	27						192.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	4	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	4	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	4	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	407	0		29	10	S5921_407_0	4	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	407	0		29	10	S5921_407_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				63.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											305.00	27						413.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	408	0		29	10	S5921_408_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	408	0		29	10	S5921_408_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	408	0		29	10	S5921_408_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	408	0		29	10	S5921_408_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	408	0		29	10	S5921_408_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	45		45				68.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	408	0		29	10	S5921_408_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											367.00	27						324.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	409	0		29	10	S5921_409_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	409	0		29	10	S5921_409_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	409	0		29	10	S5921_409_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	409	0		29	10	S5921_409_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	409	0		29	10	S5921_409_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											96.00	45		45				68.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	409	0		29	10	S5921_409_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											318.00	27						141.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	410	0		29	10	S5921_410_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	410	0		29	10	S5921_410_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	410	0		29	10	S5921_410_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	410	0		29	10	S5921_410_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	410	0		29	10	S5921_410_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											97.00	45		45				71.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	410	0		29	10	S5921_410_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											288.00	27						401.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	411	0		29	10	S5921_411_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	411	0		29	10	S5921_411_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	411	0		29	10	S5921_411_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	411	0		29	10	S5921_411_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	411	0		29	10	S5921_411_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											90.00	45		45				60.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	411	0		29	10	S5921_411_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											390.00	27						177.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	412	0		29	10	S5921_412_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	412	0		29	10	S5921_412_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	412	0		29	10	S5921_412_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	412	0		29	10	S5921_412_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	412	0		29	10	S5921_412_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	45		45				60.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	412	0		29	10	S5921_412_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											199.00	27						313.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	413	0		29	10	S5921_413_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	413	0		29	10	S5921_413_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	413	0		29	10	S5921_413_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	413	0		29	10	S5921_413_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	413	0		29	10	S5921_413_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											82.00	45		45				67.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	413	0		29	10	S5921_413_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											315.00	27						274.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	414	0		29	10	S5921_414_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	414	0		29	10	S5921_414_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	414	0		29	10	S5921_414_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	414	0		29	10	S5921_414_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	414	0		29	10	S5921_414_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											99.00	45		45				70.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	414	0		29	10	S5921_414_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											383.00	27						163.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	415	0		29	10	S5921_415_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	415	0		29	10	S5921_415_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	415	0		29	10	S5921_415_0	3	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						30.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	415	0		29	10	S5921_415_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					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	415	0		29	10	S5921_415_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											98.00	45		45				77.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	415	0		29	10	S5921_415_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											413.00	27						133.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	2	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	25.00				5.00	10.00	12.50				10.00				5.00			0.33	0.17		0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	2	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
S5953	001	0		29	10	S5953_001_0	2	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	117.50				40.00	80.00	100.00				47.00				40.00			1.57	1.33		1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											65.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	2	Specialty Tier	3	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												26	26	26					26	26	26										26	26	26				26	26	26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3	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					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												
S5953	002	0		29	10	S5953_002_0	3	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					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5953	002	0		29	10	S5953_002_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	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												
S5953	002	0		29	10	S5953_002_0	3	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	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										1		
S5953	002	0		29	10	S5953_002_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								27.00	54.00	81.00					20.00	40.00	60.00											27.00	54.00	67.50				20.00	40.00	50.00				27.00				20.00			0.90	0.67		0.90	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											65.00	45	45	45				60.00	40	40	40										45	45	45				40	40	40			45			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3	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	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	004	0		29	10	S5953_004_0	3	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	37.50				0.00	0.00	0.00				15.00				0.00			0.50	0.00		0.50	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	004	0		29	10	S5953_004_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	50.00				5.00	10.00	12.50				20.00				5.00			0.67	0.17		0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	004	0		29	10	S5953_004_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	100.00				47.00				40.00			1.57	1.33		1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	004	0		29	10	S5953_004_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											65.00	50	50	50				65.00	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	004	0		29	10	S5953_004_0	3	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												25	25	25					25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	5	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	5	Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	33.00																			5.50	11.00	16.50																11.00				11.00		0.37			0.18			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	5	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	5	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				45.79	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	5	Specialty Tier	2	11	1	1	5	1	010		01			1	30														30		31				357.20	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5993	003	0		29	10	S5993_003_0	5	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	5	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	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				58.27	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	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				427.47	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	007	0		29	10	S5993_007_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	6	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			3.00	6.00	9.00																6.00				6.00		0.20			0.10			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	007	0		29	10	S5993_007_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	6	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				54.37	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	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				454.21	26																																					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	9	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 Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	9	Generic	2	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	9	Preferred Brand	2	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				56.41	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	9	Non-Preferred Drug	2	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				79.23	36	36	36																				36															36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	9	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				875.66	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	7.50																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	9	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				36.30	20	20	20																				20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	9	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				63.99	45	45	45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				2579.17	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	001	0		29	10	S6946_001_0	5	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	001	0		29	10	S6946_001_0	5	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	001	0		29	10	S6946_001_0	5	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	001	0		29	10	S6946_001_0	5	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	36	36	36				47.00	36	36	36										36	36	36				36	36	36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	001	0		29	10	S6946_001_0	5	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	002	0		29	10	S6946_002_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	002	0		29	10	S6946_002_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	002	0		29	10	S6946_002_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	37	37	37				47.00	37	37	37										37	37	37				37	37	37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	002	0		29	10	S6946_002_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	003	0		29	10	S6946_003_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	003	0		29	10	S6946_003_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	003	0		29	10	S6946_003_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	39	39	39				47.00	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	003	0		29	10	S6946_003_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	004	0		29	10	S6946_004_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	004	0		29	10	S6946_004_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	004	0		29	10	S6946_004_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	39	39	39				47.00	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	004	0		29	10	S6946_004_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	005	0		29	10	S6946_005_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	005	0		29	10	S6946_005_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	005	0		29	10	S6946_005_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	38	38	38				47.00	38	38	38										38	38	38				38	38	38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	005	0		29	10	S6946_005_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	006	0		29	10	S6946_006_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	006	0		29	10	S6946_006_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	006	0		29	10	S6946_006_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	40	40	40				47.00	40	40	40										40	40	40				40	40	40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	006	0		29	10	S6946_006_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	007	0		29	10	S6946_007_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	007	0		29	10	S6946_007_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	007	0		29	10	S6946_007_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	39	39	39				47.00	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	007	0		29	10	S6946_007_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	008	0		29	10	S6946_008_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	008	0		29	10	S6946_008_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	008	0		29	10	S6946_008_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	37	37	37				47.00	37	37	37										37	37	37				37	37	37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	008	0		29	10	S6946_008_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	009	0		29	10	S6946_009_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	009	0		29	10	S6946_009_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	009	0		29	10	S6946_009_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	40	40	40				47.00	40	40	40										40	40	40				40	40	40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	009	0		29	10	S6946_009_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	010	0		29	10	S6946_010_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	010	0		29	10	S6946_010_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	010	0		29	10	S6946_010_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	37	37	37				47.00	37	37	37										37	37	37				37	37	37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	010	0		29	10	S6946_010_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	011	0		29	10	S6946_011_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	011	0		29	10	S6946_011_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	011	0		29	10	S6946_011_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	34	34	34				47.00	34	34	34										34	34	34				34	34	34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	011	0		29	10	S6946_011_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	012	0		29	10	S6946_012_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	012	0		29	10	S6946_012_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	012	0		29	10	S6946_012_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	39	39	39				47.00	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	012	0		29	10	S6946_012_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	013	0		29	10	S6946_013_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	013	0		29	10	S6946_013_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	013	0		29	10	S6946_013_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	38	38	38				47.00	38	38	38										38	38	38				38	38	38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	013	0		29	10	S6946_013_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	014	0		29	10	S6946_014_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	014	0		29	10	S6946_014_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	014	0		29	10	S6946_014_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	37	37	37				47.00	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	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	015	0		29	10	S6946_015_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	015	0		29	10	S6946_015_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	015	0		29	10	S6946_015_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	36	36	36				47.00	36	36	36										36	36	36				36	36	36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	015	0		29	10	S6946_015_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	016	0		29	10	S6946_016_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	016	0		29	10	S6946_016_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	016	0		29	10	S6946_016_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	39	39	39				47.00	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	016	0		29	10	S6946_016_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	017	0		29	10	S6946_017_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	017	0		29	10	S6946_017_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	017	0		29	10	S6946_017_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	40	40	40				47.00	40	40	40										40	40	40				40	40	40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	017	0		29	10	S6946_017_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	018	0		29	10	S6946_018_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	018	0		29	10	S6946_018_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	018	0		29	10	S6946_018_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	38	38	38				47.00	38	38	38										38	38	38				38	38	38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	018	0		29	10	S6946_018_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	019	0		29	10	S6946_019_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	019	0		29	10	S6946_019_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	019	0		29	10	S6946_019_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	35	35	35				47.00	35	35	35										35	35	35				35	35	35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	019	0		29	10	S6946_019_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	020	0		29	10	S6946_020_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	020	0		29	10	S6946_020_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	020	0		29	10	S6946_020_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	38	38	38				47.00	38	38	38										38	38	38				38	38	38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	020	0		29	10	S6946_020_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	021	0		29	10	S6946_021_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	021	0		29	10	S6946_021_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	021	0		29	10	S6946_021_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	39	39	39				47.00	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	021	0		29	10	S6946_021_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	022	0		29	10	S6946_022_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	022	0		29	10	S6946_022_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	022	0		29	10	S6946_022_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	40	40	40				47.00	40	40	40										40	40	40				40	40	40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	022	0		29	10	S6946_022_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	023	0		29	10	S6946_023_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	023	0		29	10	S6946_023_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	023	0		29	10	S6946_023_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	38	38	38				47.00	38	38	38										38	38	38				38	38	38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	023	0		29	10	S6946_023_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	024	0		29	10	S6946_024_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	024	0		29	10	S6946_024_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	024	0		29	10	S6946_024_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	37	37	37				47.00	37	37	37										37	37	37				37	37	37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	024	0		29	10	S6946_024_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	025	0		29	10	S6946_025_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	025	0		29	10	S6946_025_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	025	0		29	10	S6946_025_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	39	39	39				47.00	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	025	0		29	10	S6946_025_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	026	0		29	10	S6946_026_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	026	0		29	10	S6946_026_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	026	0		29	10	S6946_026_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	39	39	39				47.00	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	026	0		29	10	S6946_026_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	027	0		29	10	S6946_027_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	027	0		29	10	S6946_027_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	027	0		29	10	S6946_027_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	34	34	34				47.00	34	34	34										34	34	34				34	34	34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	027	0		29	10	S6946_027_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	028	0		29	10	S6946_028_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	028	0		29	10	S6946_028_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	028	0		29	10	S6946_028_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	40	40	40				47.00	40	40	40										40	40	40				40	40	40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	028	0		29	10	S6946_028_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	029	0		29	10	S6946_029_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	029	0		29	10	S6946_029_0	4	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				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	029	0		29	10	S6946_029_0	4	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.00	35	35	35				47.00	35	35	35										35	35	35				35	35	35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	029	0		29	10	S6946_029_0	4	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											636.00	25	25	25				636.00	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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											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												
S6946	030	0		29	10	S6946_030_0	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	030	0		29	10	S6946_030_0	5	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	030	0		29	10	S6946_030_0	5	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	031	0		29	10	S6946_031_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	031	0		29	10	S6946_031_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	031	0		29	10	S6946_031_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	032	0		29	10	S6946_032_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	032	0		29	10	S6946_032_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	032	0		29	10	S6946_032_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	033	0		29	10	S6946_033_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
S6946	033	0		29	10	S6946_033_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	033	0		29	10	S6946_033_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	034	0		29	10	S6946_034_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
S6946	034	0		29	10	S6946_034_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	034	0		29	10	S6946_034_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	035	0		29	10	S6946_035_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	035	0		29	10	S6946_035_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	036	0		29	10	S6946_036_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
S6946	036	0		29	10	S6946_036_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	036	0		29	10	S6946_036_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	037	0		29	10	S6946_037_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	037	0		29	10	S6946_037_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	037	0		29	10	S6946_037_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	038	0		29	10	S6946_038_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
S6946	038	0		29	10	S6946_038_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	038	0		29	10	S6946_038_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	039	0		29	10	S6946_039_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
S6946	039	0		29	10	S6946_039_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	039	0		29	10	S6946_039_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	040	0		29	10	S6946_040_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	040	0		29	10	S6946_040_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	041	0		29	10	S6946_041_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	041	0		29	10	S6946_041_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	041	0		29	10	S6946_041_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	042	0		29	10	S6946_042_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	042	0		29	10	S6946_042_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	042	0		29	10	S6946_042_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	043	0		29	10	S6946_043_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	043	0		29	10	S6946_043_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	044	0		29	10	S6946_044_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	044	0		29	10	S6946_044_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	045	0		29	10	S6946_045_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	045	0		29	10	S6946_045_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	046	0		29	10	S6946_046_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	046	0		29	10	S6946_046_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	046	0		29	10	S6946_046_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	047	0		29	10	S6946_047_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	047	0		29	10	S6946_047_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	047	0		29	10	S6946_047_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	048	0		29	10	S6946_048_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	048	0		29	10	S6946_048_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	048	0		29	10	S6946_048_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	049	0		29	10	S6946_049_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	049	0		29	10	S6946_049_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	049	0		29	10	S6946_049_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	050	0		29	10	S6946_050_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	050	0		29	10	S6946_050_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	051	0		29	10	S6946_051_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	051	0		29	10	S6946_051_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	052	0		29	10	S6946_052_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	052	0		29	10	S6946_052_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	053	0		29	10	S6946_053_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	053	0		29	10	S6946_053_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	053	0		29	10	S6946_053_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	054	0		29	10	S6946_054_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	054	0		29	10	S6946_054_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	055	0		29	10	S6946_055_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	055	0		29	10	S6946_055_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	056	0		29	10	S6946_056_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	056	0		29	10	S6946_056_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	057	0		29	10	S6946_057_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	057	0		29	10	S6946_057_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	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	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	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	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	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												
S6946	058	0		29	10	S6946_058_0	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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												
S6946	058	0		29	10	S6946_058_0	4	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.00	50	50	50				50.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	058	0		29	10	S6946_058_0	4	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											796.00	25	25	25				796.00	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	3	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													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	3	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.83	21		21				41.47	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	3	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											73.34	44						67.97	42												42						42					44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.15	21		21				40.00	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											81.78	45						72.80	43												43						43					45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.91	20		20				40.88	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											74.39	44						71.34	42												42						42					44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.84	20		20				39.97	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											79.59	47						74.17	45												45						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											42.79	20		20				38.87	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											83.00	49						74.37	47												47						47					49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.00	21		21				42.15	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											79.94	43						74.37	41												41						41					43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											47.29	21		21				43.07	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											76.86	48						68.60	46												46						46					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											47.89	22		22				44.19	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	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											79.87	46						69.70	44												44						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											41.72	20		20				38.59	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											75.64	45						69.27	43												43						43					45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											42.26	20		20				38.91	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											78.15	43						70.07	41												41						41					43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.31	21		21				39.80	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											71.11	46						65.02	44												44						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											49.30	22		22				46.88	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	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											75.86	43						65.80	41												41						41					43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.86	21		21				42.53	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											73.21	44						66.32	42												42						42					44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											42.74	20		20				39.15	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											78.00	49						70.82	47												47						47					49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											41.06	19		19				37.01	17		17												17						17			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											77.56	46						72.02	44												44						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											47.23	21		21				44.16	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											76.92	43						68.81	41												41						41					43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											41.83	20		20				38.04	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											72.47	46						66.12	44												44						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											42.33	21		21				38.75	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											70.83	45						65.06	43												43						43					45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.41	20		20				39.62	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											76.00	48						69.46	46												46						46					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											42.33	20		20				38.75	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											69.30	43						63.70	41												41						41					43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.00	20		20				42.01	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											83.95	48						76.14	46												46						46					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											39.81	19		19				36.49	17		17												17						17			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											69.88	43						64.74	41												41						41					43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											39.63	19		19				35.53	17		17												17						17			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											80.59	48						74.72	46												46						46					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											40.65	19		19				36.89	17		17												17						17			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											79.78	47						73.19	45												45						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.81	19		19				41.15	17		17												17						17			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											80.40	45						75.50	43												43						43					45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.42	19		19				39.83	17		17												17						17			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											78.38	43						73.88	41												41						41					43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.97	21		21				43.39	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											83.48	44						76.66	42												42						42					44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											48.26	22		22				46.09	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	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											73.64	43						67.49	41												41						41					43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											39.49	18		18				35.84	16		16												16						16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											72.84	43						69.23	41												41						41					43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.91	21		21				41.93	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											70.43	44						65.36	42												42						42					44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											42.31	19		19				38.24	17		17												17						17			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											87.07	44						79.57	42												42						42					44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.96	20		20				42.36	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											82.55	46						77.18	44												44						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													3.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	1	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					3.00		9.00													9.00						9.00				10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	1	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											41.01	18		18				36.92	16		16												16						16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											72.18	42						66.52	40												40						40					42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	2	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													0.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	2	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.07	25		25				42.72	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.70	46						90.88	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	072	0		29	10	S7126_072_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	072	0		29	10	S7126_072_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	072	0		29	10	S7126_072_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.59	25		25				42.07	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.08	47						94.50	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	072	0		29	10	S7126_072_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	073	0		29	10	S7126_073_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	073	0		29	10	S7126_073_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	073	0		29	10	S7126_073_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.60	25		25				42.34	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.28	46						90.19	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	073	0		29	10	S7126_073_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	074	0		29	10	S7126_074_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	074	0		29	10	S7126_074_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	074	0		29	10	S7126_074_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.80	25		25				42.38	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.55	44						85.94	42												44						42					44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	074	0		29	10	S7126_074_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	075	0		29	10	S7126_075_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	075	0		29	10	S7126_075_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	075	0		29	10	S7126_075_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.14	25		25				42.33	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											97.90	44						85.49	42												44						42					44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	075	0		29	10	S7126_075_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	076	0		29	10	S7126_076_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	076	0		29	10	S7126_076_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	076	0		29	10	S7126_076_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.49	25		25				42.07	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.23	46						89.81	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	076	0		29	10	S7126_076_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	077	0		29	10	S7126_077_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	077	0		29	10	S7126_077_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	077	0		29	10	S7126_077_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.41	25		25				41.85	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.97	45						86.60	43												45						43					45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	077	0		29	10	S7126_077_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	078	0		29	10	S7126_078_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	078	0		29	10	S7126_078_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	078	0		29	10	S7126_078_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.42	25		25				41.74	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.90	48						94.93	46												48						46					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	078	0		29	10	S7126_078_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	079	0		29	10	S7126_079_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	079	0		29	10	S7126_079_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	079	0		29	10	S7126_079_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.11	25		25				41.84	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.93	47						91.71	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	079	0		29	10	S7126_079_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	080	0		29	10	S7126_080_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	080	0		29	10	S7126_080_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	080	0		29	10	S7126_080_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.98	25		25				42.10	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.08	46						90.15	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	080	0		29	10	S7126_080_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	081	0		29	10	S7126_081_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	081	0		29	10	S7126_081_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	081	0		29	10	S7126_081_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.41	25		25				41.06	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.82	50						97.18	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	081	0		29	10	S7126_081_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	082	0		29	10	S7126_082_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	082	0		29	10	S7126_082_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	082	0		29	10	S7126_082_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.82	25		25				42.36	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.76	45						88.17	43												45						43					45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	082	0		29	10	S7126_082_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	083	0		29	10	S7126_083_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	083	0		29	10	S7126_083_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	083	0		29	10	S7126_083_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.41	25		25				41.95	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.92	46						88.93	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	083	0		29	10	S7126_083_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	084	0		29	10	S7126_084_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	084	0		29	10	S7126_084_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	084	0		29	10	S7126_084_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.18	25		25				41.47	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.93	47						90.41	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	084	0		29	10	S7126_084_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	085	0		29	10	S7126_085_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	085	0		29	10	S7126_085_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	085	0		29	10	S7126_085_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.99	25		25				41.37	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.82	46						87.03	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	085	0		29	10	S7126_085_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	086	0		29	10	S7126_086_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	086	0		29	10	S7126_086_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	086	0		29	10	S7126_086_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.84	25		25				41.72	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.28	46						88.89	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	086	0		29	10	S7126_086_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	087	0		29	10	S7126_087_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	087	0		29	10	S7126_087_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	087	0		29	10	S7126_087_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.54	25		25				41.39	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.03	45						85.01	43												45						43					45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	087	0		29	10	S7126_087_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	088	0		29	10	S7126_088_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	088	0		29	10	S7126_088_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	088	0		29	10	S7126_088_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.19	25		25				41.02	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.63	47						89.48	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	088	0		29	10	S7126_088_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	089	0		29	10	S7126_089_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	089	0		29	10	S7126_089_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	089	0		29	10	S7126_089_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.14	25		25				41.40	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.89	46						86.47	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	089	0		29	10	S7126_089_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	090	0		29	10	S7126_090_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	090	0		29	10	S7126_090_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	090	0		29	10	S7126_090_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.08	25		25				41.17	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.56	47						89.54	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	090	0		29	10	S7126_090_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	091	0		29	10	S7126_091_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	091	0		29	10	S7126_091_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	091	0		29	10	S7126_091_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.55	25		25				41.87	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.45	46						89.05	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	091	0		29	10	S7126_091_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	092	0		29	10	S7126_092_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	092	0		29	10	S7126_092_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	092	0		29	10	S7126_092_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											47.02	25		25				40.77	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.56	48						90.79	46												48						46					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	092	0		29	10	S7126_092_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	093	0		29	10	S7126_093_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	093	0		29	10	S7126_093_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	093	0		29	10	S7126_093_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.59	25		25				41.23	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.98	47						89.16	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	093	0		29	10	S7126_093_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	094	0		29	10	S7126_094_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.72	25		25				41.59	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.30	46						88.59	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	095	0		29	10	S7126_095_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	095	0		29	10	S7126_095_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	095	0		29	10	S7126_095_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											48.07	25		25				42.25	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.35	48						95.71	46												48						46					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	095	0		29	10	S7126_095_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	096	0		29	10	S7126_096_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	096	0		29	10	S7126_096_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	096	0		29	10	S7126_096_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											48.51	25		25				42.61	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.23	46						93.00	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	096	0		29	10	S7126_096_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	097	0		29	10	S7126_097_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	097	0		29	10	S7126_097_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	097	0		29	10	S7126_097_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.71	25		25				42.68	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.66	46						90.73	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	097	0		29	10	S7126_097_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	098	0		29	10	S7126_098_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	098	0		29	10	S7126_098_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	098	0		29	10	S7126_098_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.93	25		25				42.32	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.12	47						93.36	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	098	0		29	10	S7126_098_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	099	0		29	10	S7126_099_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	099	0		29	10	S7126_099_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	099	0		29	10	S7126_099_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											48.36	25		25				42.40	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.96	48						95.43	46												48						46					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	099	0		29	10	S7126_099_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	100	0		29	10	S7126_100_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	100	0		29	10	S7126_100_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	100	0		29	10	S7126_100_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.02	25		25				41.92	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.02	45						87.38	43												45						43					45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	100	0		29	10	S7126_100_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	101	0		29	10	S7126_101_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	101	0		29	10	S7126_101_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	101	0		29	10	S7126_101_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.76	25		25				42.65	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.98	46						91.68	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	101	0		29	10	S7126_101_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	102	0		29	10	S7126_102_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.04	25		25				43.31	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.43	43						85.41	41												43						41					43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	103	0		29	10	S7126_103_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					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												
S7126	103	0		29	10	S7126_103_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													39.00						39.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	103	0		29	10	S7126_103_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											48.14	25		25				42.55	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	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.02	46						94.72	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	103	0		29	10	S7126_103_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	001	0		29	10	S7694_001_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.82	20	20	20				38.86	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											78.22	37	37	37				69.76	33	33	33										37	37	37				33	33	33			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											903.14	25						903.14	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	002	0		29	10	S7694_002_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											52.86	20	20	20				39.65	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.34	37	37	37				74.75	34	34	34										37	37	37				34	34	34			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											752.59	25						752.59	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	003	0		29	10	S7694_003_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											52.12	20	20	20				39.09	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											77.06	33	33	33				65.38	28	28	28										33	33	33				28	28	28			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											755.95	25						755.95	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	004	0		29	10	S7694_004_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.43	20	20	20				38.57	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.71	32	32	32				66.80	29	29	29										32	32	32				29	29	29			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											847.16	25						847.16	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	005	0		29	10	S7694_005_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.93	20	20	20				38.95	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											77.50	37	37	37				69.12	33	33	33										37	37	37				33	33	33			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											735.91	25						735.91	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	006	0		29	10	S7694_006_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.69	20	20	20				38.77	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											78.55	39	39	39				68.48	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	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											796.09	25						796.09	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	007	0		29	10	S7694_007_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.48	20	20	20				40.11	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.02	37	37	37				73.16	33	33	33										37	37	37				33	33	33			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											762.02	25						762.02	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	008	0		29	10	S7694_008_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											52.88	20	20	20				39.66	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											83.10	37	37	37				71.87	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	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											695.87	25						695.87	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	009	0		29	10	S7694_009_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											49.08	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	009	0		29	10	S7694_009_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											77.63	35	35	35				66.54	30	30	30										35	35	35				30	30	30			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											687.86	25						687.86	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	010	0		29	10	S7694_010_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.61	20	20	20				35.71	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	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	31	31	31				59.36	28	28	28										31	31	31				28	28	28			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											730.64	25						730.64	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	011	0		29	10	S7694_011_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											52.43	20	20	20				39.32	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											76.33	33	33	33				69.39	30	30	30										33	33	33				30	30	30			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											835.06	25						835.06	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	012	0		29	10	S7694_012_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.63	20	20	20				38.72	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											72.53	34	34	34				61.86	29	29	29										34	34	34				29	29	29			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											679.01	25						679.01	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	014	0		29	10	S7694_014_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											48.60	20	20	20				36.45	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											67.20	32	32	32				60.90	29	29	29										32	32	32				29	29	29			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											672.96	25						672.96	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	015	0		29	10	S7694_015_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											52.04	20	20	20				39.03	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	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	34	34	34				67.57	30	30	30										34	34	34				30	30	30			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											769.83	25						769.83	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	016	0		29	10	S7694_016_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											49.18	20	20	20				36.88	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											59.85	28	28	28				57.71	27	27	27										28	28	28				27	27	27			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											763.83	25						763.83	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	017	0		29	10	S7694_017_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.18	20	20	20				35.38	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											60.31	29	29	29				58.23	28	28	28										29	29	29				28	28	28			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											761.27	25						761.27	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	018	0		29	10	S7694_018_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.13	20	20	20				34.59	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	1	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											72.81	36	36	36				64.72	32	32	32										36	36	36				32	32	32			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											861.56	25						861.56	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	019	0		29	10	S7694_019_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.37	20	20	20				37.78	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	1	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				72.69	34	34	34										37	37	37				34	34	34			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											938.86	25						938.86	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	020	0		29	10	S7694_020_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.89	20	20	20				38.92	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											69.71	35	35	35				63.73	32	32	32										35	35	35				32	32	32			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											735.34	25						735.34	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	021	0		29	10	S7694_021_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.47	20	20	20				40.10	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.19	37	37	37				74.54	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	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											889.53	25						889.53	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	022	0		29	10	S7694_022_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.69	20	20	20				38.77	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.34	34	34	34				71.77	30	30	30										34	34	34				30	30	30			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											717.07	25						717.07	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	023	0		29	10	S7694_023_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.32	20	20	20				39.99	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	1	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.00	36	36	36				70.61	31	31	31										36	36	36				31	31	31			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											847.41	25						847.41	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	024	0		29	10	S7694_024_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.70	20	20	20				38.02	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	1	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.53	38	38	38				70.80	33	33	33										38	38	38				33	33	33			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											933.75	25						933.75	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	025	0		29	10	S7694_025_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.16	20	20	20				39.87	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	1	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											84.11	36	36	36				72.42	31	31	31										36	36	36				31	31	31			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											890.33	25						890.33	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	026	0		29	10	S7694_026_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.50	20	20	20				34.87	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											67.02	32	32	32				60.74	29	29	29										32	32	32				29	29	29			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											870.56	25						870.56	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	027	0		29	10	S7694_027_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											49.12	20	20	20				36.84	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											62.96	30	30	30				56.67	27	27	27										30	30	30				27	27	27			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											784.23	25						784.23	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	028	0		29	10	S7694_028_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.86	20	20	20				35.90	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											74.45	34	34	34				65.69	30	30	30										34	34	34				30	30	30			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											808.29	25						808.29	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	029	0		29	10	S7694_029_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											49.91	20	20	20				37.43	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	1	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.77	38	38	38				75.31	35	35	35										38	38	38				35	35	35			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											900.02	25						900.02	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	030	0		29	10	S7694_030_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.90	20	20	20				35.17	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											77.23	39	39	39				67.33	34	34	34										39	39	39				34	34	34			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											869.54	25						869.54	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	031	0		29	10	S7694_031_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.42	20	20	20				34.07	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											68.61	32	32	32				60.03	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	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											695.25	25						695.25	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	032	0		29	10	S7694_032_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.64	20	20	20				38.73	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											84.01	35	35	35				74.41	31	31	31										35	35	35				31	31	31			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											806.62	25						806.62	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	033	0		29	10	S7694_033_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.94	20	20	20				40.46	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	1	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.81	39	39	39				81.98	36	36	36										39	39	39				36	36	36			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											921.26	25						921.26	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	1	Preferred Generic	2	01	1	2	1	1		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												
S7694	034	0		29	10	S7694_034_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											55.62	20	20	20				41.72	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.75	34	34	34				69.06	31	31	31										34	34	34				31	31	31			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											775.88	25						775.88	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	1	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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												
S7694	070	0		29	10	S7694_070_0	1	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	6.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.89	20	20	20				35.17	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	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.19	35	35	35				66.92	32	32	32										35	35	35				32	32	32			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	1	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											678.90	25						678.90	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	121	0		29	10	S7694_121_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.06	43	43	43				92.15	40	40	40										43	43	43				40	40	40			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	121	0		29	10	S7694_121_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1090.81	25						1090.81	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	122	0		29	10	S7694_122_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.28	49	49	49				90.26	45	45	45										49	49	49				45	45	45			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	122	0		29	10	S7694_122_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1007.93	25						1007.93	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	123	0		29	10	S7694_123_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.92	50	50	50				81.83	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1371.78	25						1371.78	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	124	0		29	10	S7694_124_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.21	50	50	50				84.79	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1318.34	25						1318.34	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	125	0		29	10	S7694_125_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.22	50	50	50				81.20	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1209.97	25						1209.97	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	126	0		29	10	S7694_126_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.39	50	50	50				95.39	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1402.04	25						1402.04	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	127	0		29	10	S7694_127_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											93.12	50	50	50				83.81	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1050.27	25						1050.27	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	128	0		29	10	S7694_128_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											92.92	50	50	50				83.63	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1033.12	25						1033.12	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	129	0		29	10	S7694_129_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.63	50	50	50				85.17	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1115.60	25						1115.60	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	130	0		29	10	S7694_130_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.33	50	50	50				79.50	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											880.58	25						880.58	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	131	0		29	10	S7694_131_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.06	50	50	50				80.16	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1374.96	25						1374.96	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	132	0		29	10	S7694_132_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.40	49	49	49				90.37	45	45	45										49	49	49				45	45	45			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	132	0		29	10	S7694_132_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1317.62	25						1317.62	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	133	0		29	10	S7694_133_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.14	50	50	50				73.02	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1240.16	25						1240.16	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	134	0		29	10	S7694_134_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											84.11	50	50	50				75.70	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1141.69	25						1141.69	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	135	0		29	10	S7694_135_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.96	47	47	47				87.09	45	45	45										47	47	47				45	45	45			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	135	0		29	10	S7694_135_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1043.65	25						1043.65	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	136	0		29	10	S7694_136_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.38	50	50	50				81.34	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	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1370.66	25						1370.66	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	137	0		29	10	S7694_137_0	1	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	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	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	86.00				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	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.64	44	44	44				89.67	40	40	40										44	44	44				40	40	40			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	137	0		29	10	S7694_137_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.07	25						955.07	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	1	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					5.00	10.00	15.00					5.00	10.00	15.00																15.00				15.00			0.50	0.17	0.17			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8067	001	0		29	10	S8067_001_0	1	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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, Select Care Drugs												
S8067	001	0		29	10	S8067_001_0	1	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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, Select Care Drugs												
S8067	001	0		29	10	S8067_001_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											86.29	50	50	50				86.29	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	1	Specialty Tier	3	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												
S8067	001	0		29	10	S8067_001_0	1	Select Care Drugs	3	01	1	2	6	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					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												
S8067	003	0		29	10	S8067_003_0	1	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					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, Select Care Drugs												
S8067	003	0		29	10	S8067_003_0	1	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					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, Select Care Drugs												
S8067	003	0		29	10	S8067_003_0	1	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					38.00	76.00	114.00					38.00	76.00	114.00																45.00				45.00			1.50	1.27	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	1	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					88.00	176.00	264.00					88.00	176.00	264.00																95.00				95.00			3.17	2.93	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	1	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8067	003	0		29	10	S8067_003_0	1	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8182	001	0		29	10	S8182_001_0	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	3.00																5.00				5.00			0.17	0.03	0.03			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	001	0		29	10	S8182_001_0	4	Generic	3	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					4.00	8.00	12.00					4.00	8.00	12.00																10.00				10.00			0.33	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	001	0		29	10	S8182_001_0	4	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					46.00	92.00	138.00					46.00	92.00	138.00																46.00				46.00			1.53	1.53	1.53			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	001	0		29	10	S8182_001_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											92.40	35	35	35				92.40	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	001	0		29	10	S8182_001_0	4	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	003	0		29	10	S8182_003_0	4	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	3.00																5.00				5.00			0.17	0.03	0.03			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	003	0		29	10	S8182_003_0	4	Generic	3	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	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	003	0		29	10	S8182_003_0	4	Preferred Brand	3	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											41.92	22	22	22				41.92	22	22	22				22	22	22															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	003	0		29	10	S8182_003_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											96.84	38	38	38				96.84	38	38	38				38	38	38															38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	003	0		29	10	S8182_003_0	4	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	005	0		29	10	S8182_005_0	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	005	0		29	10	S8182_005_0	4	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	4	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	005	0		29	10	S8182_005_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											74.24	50	50	50				74.24	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	005	0		29	10	S8182_005_0	4	Specialty Tier	4	11	1	1	5	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	4	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					1.00	2.00	3.00					1.00	2.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	006	0		29	10	S8182_006_0	4	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	4	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	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	006	0		29	10	S8182_006_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											70.93	50	50	50				70.93	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	006	0		29	10	S8182_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
